Provider Demographics
NPI:1043793672
Name:COOPER, OLIVIA BABB (FNP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:BABB
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 COUNTY ROAD 418
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9554
Mailing Address - Country:US
Mailing Address - Phone:662-832-6152
Mailing Address - Fax:
Practice Address - Street 1:2706 W OXFORD LOOP STE 105
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-0658
Practice Address - Country:US
Practice Address - Phone:662-550-4250
Practice Address - Fax:662-550-4612
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily