Provider Demographics
NPI:1235107400
Name:COOPER, CHRISTINE KAY (ARNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:ARNP
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 766351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LN
Practice Address - Street 2:SUITE 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4721
Practice Address - Country:US
Practice Address - Phone:502-896-2500
Practice Address - Fax:502-896-2527
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1084979363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013570Medicaid
KY000000744517OtherANTHEM- KCNS
IN20046780OtherIHCP INDIANA MEDICAID
IN200426780Medicaid
KY50035395OtherPASSPORT- KCNS
KY0941308Medicare ID - Type Unspecified
KY50035395OtherPASSPORT- KCNS
IN200426780Medicaid