Individual
TANESSA COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
2015 UTAH DR, TAHLEQUAH, OK 74464-8800
(479) 326-2052
Mailing address
2015 UTAH DR, TAHLEQUAH, OK 74464-8800
(479) 326-2052
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/18/2024
Last updated
04/18/2024
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