Individual
JACEY COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
475 N HIGHWAY 25 W STE 100, WILLIAMSBURG, KY 40769-1576
(606) 549-2930
Mailing address
PO BOX 247, JELLICO, TN 37762-0247
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
7082
TN
363AM0700X
Medical Physician Assistant
Primary
PA3827
KY
363AM0700X
Medical Physician Assistant
Primary
—
KY
Other
Enumeration date
01/21/2025
Last updated
07/20/2026
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