Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 854822 | MS |
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP07104 | LA |
NPI | 1003151945 |
---|---|
Provider Name | Richard Todd Cooper |
First Address | Slidell, LA 70461-4142 |
Second Address | Slidell, LA 70458-2939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2012 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09305086 | (05) | MS |
2319345 | (05) | LA |