Individual
KIM COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5903 RIDGEWOOD RD STE 310, JACKSON, MS 39211-3702
(601) 899-3310
Mailing address
5903 RIDGEWOOD RD STE 310, JACKSON, MS 39211-3702
(601) 899-3310
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R639893
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126107
—
MS
01
—
202011213A
BLUE CROSS
MS
Enumeration date
07/11/2006
Last updated
06/25/2010
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