Provider Demographics
NPI:1578117149
Name:COOPER, JORDYN (APRN)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 BAPTISTE DR STE A
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1888
Mailing Address - Country:US
Mailing Address - Phone:913-294-2305
Mailing Address - Fax:913-294-2305
Practice Address - Street 1:1401 BAPTISTE DR STE A
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1888
Practice Address - Country:US
Practice Address - Phone:913-294-2305
Practice Address - Fax:913-294-2305
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015018000163WN0002X
KS53-79001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care