Individual
KELCEY RAYE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
4250 BETHEL RD, OLIVE BRANCH, MS 38654-8737
(901) 516-1290
(901) 516-1220
Mailing address
1211 UNION AVE STE 330, MEMPHIS, TN 38104-6655
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
PA00617
MS
Other
Enumeration date
12/29/2017
Last updated
05/27/2025
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