Individual
COOPER NICKELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 214-3930
(928) 214-3882
Mailing address
PO BOX 67, FLAGSTAFF, AZ 86002-0067
(928) 214-3930
(928) 214-3882
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
010116
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/20/2020
Last updated
07/03/2023
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