Provider Demographics
NPI:1487605648
Name:COOPER, JAMES ROY (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROY
Last Name:COOPER
Suffix:
Gender:M
Credentials:CRNA
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 2723
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803
Mailing Address - Country:US
Mailing Address - Phone:775-778-6634
Mailing Address - Fax:775-778-6634
Practice Address - Street 1:2001 ERRECART BLVD
Practice Address - Street 2:NORTHEASTERN NEVADA REGIONAL HOSPITAL
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-738-5151
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCRNA000182367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P06640Medicare UPIN
NV35147Medicare ID - Type Unspecified