Individual
JESSICA EVERINGHAM COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6845 E US HIGHWAY 36 STE 600, AVON, IN 46123-8132
(317) 272-4920
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02006319A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430C44
MEDICARE
IN
05
—
300014123
—
IN
01
—
PENDING
STATE LICENSE
IN
Enumeration date
05/01/2018
Last updated
01/24/2023
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