Doctor Name: | PAMELA LYNN COOPER |
NPI Number: | 1003072349 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PMHNP-BC |
License Number: | 4704209177 |
Business Practice Address: | 12734 Kenwood Ln Suite 84 Fort Myers, FL - 339075666 |
Business Phone Number: | 8669365250 |
Business Fax Number: | |
Mailing Address: | 12734 Kenwood Ln, Suite 84 FORT MYERS |
State: | FL |
Postal Code: | 339075666 |
Phone Number: | 8669365250 |
Fax Number: | |
NPI Enumeration Date: | 08/06/2008 |
NPI Last Update Date: | 08/06/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | 4704209177 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |