Individual
JENNIFER MICKLE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2295 E 14TH ST STE 100, WINSTON SALEM, NC 27105-6804
(336) 713-8860
(336) 713-8862
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
120534
OH
208000000X
Pediatrics Physician
Primary
2013-00225
NC
208000000X
Pediatrics Physician
ME126708
FL
Other
Enumeration date
05/14/2010
Last updated
11/01/2017
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