Kelly Cooper, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

32365 Issued in TX

Practice address

221 3Rd St W BLDG 1040
Jbsa Randolph, TX 78150-4800

Phone

(210) 652-3301

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1386191252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-3301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "151 Bodin Cir",
            "address_purpose": "LOCATION",
            "city": "Travis AFB",
            "state": "CA",
            "postal_code": "945351801",
            "country_code": "US",
            "telephone_number": "707-423-7008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "224 W D.L. Ingram Ave",
            "address_2": "Bldg 1408",
            "address_purpose": "LOCATION",
            "city": "Cannon AFB",
            "state": "NM",
            "postal_code": "88103",
            "country_code": "US",
            "telephone_number": "575-784-4041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOPER",
        "first_name": "KELLY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "32365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Bowman, M.D.
• Kimberly Livingston Broom, M.D.
• Jacqueline E Bvlgari, PA-C
• John D Carlson, MSW
• Raymond E Collier, PA-C
• Michael Curtin, DPT,MS, OCS, FAAOMPT
• Jacob R Dybdahl, PT, DPT, FAAOMPT
• Melanie Jane Ellis, PA
• Timothy T Erhardt, LICSW, LCSW
• Oscar Escano, MD

• General Practice Dentistry in Jbsa Randolph, TX
• Providers in Jbsa Randolph, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.