Provider Demographics
NPI:1487976692
Name:COOPER, TERESA (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 OLIVE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5220
Mailing Address - Country:US
Mailing Address - Phone:281-820-0918
Mailing Address - Fax:
Practice Address - Street 1:9915 OLIVE BROOK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5220
Practice Address - Country:US
Practice Address - Phone:281-820-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661106163W00000X, 163WC0400X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult