Individual
KELLY M COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
14100 PARKWAY COMMONS DR, SUITE 100, OKLAHOMA CITY, OK 73134-6103
(405) 286-9820
(405) 286-9813
Mailing address
14100 PARKWAY COMMONS DR, SUITE 100, OKLAHOMA CITY, OK 73134-6103
(405) 286-9820
(405) 286-9813
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
874
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200052210A
—
OK
01
—
446586302001
BC/BS
OK
01
—
446586302003
BC/BS OF OK
OK
01
—
P00083013
MEDICARE RR
OK
01
—
P00454308
MEDICARE RR
OK
Enumeration date
05/16/2006
Last updated
02/17/2014
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