Wijewardane, Johnnie Susan Cooper
Wijewardane, Johnnie Susan Cooper is an sole proprietor health care provider with primary practice located at 1430 Cedar Creek Ln , Starkville MS 39759-8488. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wijewardane, Johnnie Susan Cooper can be contacted via phone (662) 312-1021.Contact Information
Primary practice address
1430 Cedar Creek Ln
Starkville MS 39759-8488
Phone: (662) 312-1021
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | R852708 | Mississippi |
Profile Details
| NPI number | 1316196850 |
|---|---|
| LBN Legal business name | Wijewardane, Johnnie Susan Cooper |
| Credentials | PHD, FNP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 9th, 2008 |
| Last updated | Mar 15th, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316196850 | NPPES |
| Mississippi | MEDICAID | 04887214 |
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