Individual
KATRINA COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 GIBSON FOREST DR, LEXINGTON, SC 29072-3482
(803) 347-6610
Mailing address
501 GIBSON FOREST DR, LEXINGTON, SC 29072-3482
(803) 347-6610
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
102704
SC
163WG0000X
General Practice Registered Nurse
102704
SC
163WH0200X
Home Health Registered Nurse
102704
SC
163WM0705X
Medical-Surgical Registered Nurse
102704
SC
163WP0200X
Pediatric Registered Nurse
102704
SC
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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