Provider Demographics
NPI:1366058224
Name:COOPER, JESSE FAYE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:FAYE
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:KIRGIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 879749
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-9749
Mailing Address - Country:US
Mailing Address - Phone:907-952-8944
Mailing Address - Fax:907-519-6493
Practice Address - Street 1:1981 E PALMER WASILLA HWY STE 200
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7287
Practice Address - Country:US
Practice Address - Phone:907-202-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK164536363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily