Individual
CRYSTAL ANN COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
39 CUMBERLAND GAP PLZ, GRAY, KY 40734-4536
(606) 526-9005
(606) 526-8607
Mailing address
PO BOX 1325, CORBIN, KY 40702-1325
(606) 526-8131
(606) 528-8661
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19111
TN
363LF0000X
Family Nurse Practitioner
3007739
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100225480
—
KY
01
—
K068550
MEDICARE PTAN
KY
05
—
Q007160
—
TN
Enumeration date
11/01/2012
Last updated
05/25/2022
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