Individual
LEANN DALTON COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
124 DOWELL RD, RUSSELL SPRINGS, KY 42642
(270) 866-2440
(270) 866-2442
Mailing address
124 DOWELL RD, RUSSELL SPRINGS, KY 42642-4278
(270) 866-2440
(270) 866-2442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50197
KY
207Q00000X
Family Medicine Physician
R3457
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71000382620
—
KY
05
—
R3457
—
KY
Enumeration date
07/05/2014
Last updated
03/12/2019
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