Provider Demographics
NPI:1174322630
Name:COOPER, BRADY AUSTIN (PA)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:AUSTIN
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:DRUMMONDS
Mailing Address - State:TN
Mailing Address - Zip Code:38023-0296
Mailing Address - Country:US
Mailing Address - Phone:901-871-7342
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 296
Practice Address - Street 2:
Practice Address - City:DRUMMONDS
Practice Address - State:TN
Practice Address - Zip Code:38023-0296
Practice Address - Country:US
Practice Address - Phone:901-871-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant