Individual
KELLY COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
12 6TH ST, WATERFORD, NY 12188-2306
(518) 237-0652
(518) 233-0898
Mailing address
12 6TH ST, WATERFORD, NY 12188-2306
(518) 237-0652
(518) 233-0898
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
513304-1
NY
Other
Enumeration date
11/07/2011
Last updated
11/07/2011
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