Provider Demographics
NPI:1871392720
Name:COOPER, PHILLIP SHELTON
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SHELTON
Last Name:COOPER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 N 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4715
Mailing Address - Country:US
Mailing Address - Phone:531-800-5326
Mailing Address - Fax:
Practice Address - Street 1:1815 1ST CORSO
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2245
Practice Address - Country:US
Practice Address - Phone:402-969-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider