Tiffany Danielle Cooper | Blytheville, AR • PECOS Search

Tiffany Danielle Cooper

Case Manager/Care Coordinator

Other Service Providers

209 S Lockard St, Blytheville, AR 72315-2541

(870) 763-2139 (870) 972-4939

PECOS Enrollment

Based on the most recent information from CMS, provider Tiffany Danielle Cooper does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1578114419
Provider Type
Individual
Full Name
Cooper, Tiffany Danielle
Title
Ms.
Credential
CHILD CIS

Gender
Female
Sole Proprietor
Yes
Enumeration Date
9/23/2019
Last Updated
9/23/2019

Contact Information

Practice Location

209 S Lockard St, Blytheville, AR 72315-2541

(870) 763-5056

Mailing Location

2707 Browns Ln, Jonesboro, AR 72401-7213

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 171M00000X Primary	Description Case Manager/Care Coordinator Other Service Providers	License Unlisted Issuer