Provider Demographics
NPI:1912172305
Name:COOPER, THOMAS EUGENE (FNP-C, ACNP-BC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EUGENE
Last Name:COOPER
Suffix:
Gender:M
Credentials:FNP-C, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 WESLEY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6426
Practice Address - Country:US
Practice Address - Phone:901-516-5741
Practice Address - Fax:901-516-5986
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201709334NP-PP-ACUTE363LA2100X
OK200917363LA2100X
AKAPN1324363LF0000X
TN13427363LF0000X, 363LA2100X
MTNUR-APRN 101543363LF0000X
NDR34723363LF0000X
MN5502363LF0000X
OR201708800NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty