Jackson Cooper
Nurse Practitioner, Family in Jackson, MS. Individual provider (NPI-1).
NPI number1043056757
StatusActive
Last updated in NPPESJul 2, 2024
Details
- NPI
- 1043056757
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jackson Cooper
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 2, 2024
- Certification date
- Jul 2, 2024
- Last updated
- Jul 2, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 906765 | MS | Yes |
Practice location
971 Lakeland Dr Ste 1052Jackson, MS 39216-4609
Phone 601-981-9503
Mailing address
971 Lakeland Dr Ste 1052Jackson, MS 39216-4609
Phone 601-981-9503
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