Jacey Cooper – Medical Physician Assistant

Key facts

NPI: 1689486458
Entity type: Individual (NPI type 1)
Primary specialty: Medical Physician Assistant 363AM0700X
License: PA3827 (KY)
Practice address: 475 N Highway 25 W Ste 100
Williamsburg, KY 40769-1576
Phone: (606) 549-2930
NPI assigned: Jan 21, 2025
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Williamsburg Family Medicine Center Rural Health Clinic/Center · Williamsburg, KY · NPI 1376689620

Medicare reassignment Care Compare group NPD (past) KY

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Baptist Healthcare System, Inc General Acute Care Hospital · Corbin, KY · NPI 1902865389

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Physician Assistant
Education: Other, 2025
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Williamsburg Family Medicine Center (7 clinicians)

Practice addresses (Care Compare)

475 N Hwy 25 W
Suite 100
Williamsburg, KY 40769-1576
Phone (606) 549-2930

Hospital & facility affiliations

Baptist Health Corbin Hospital · Corbin, KY · CCN 180080

Medicare participation

Medicare fee-for-service enrollment: Enrolled in KY
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20260401003262	KY	Practitioner - Physician Assistant	6002391554	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Williamsburg Family Medicine Center		Past	Accepting new patients

Interoperability endpoints

FHIR API: https://api.platform.athenahealth.com/24026/brand/1/csg/1/fhir/r4

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Medical Physician Assistant	363AM0700X	7082	TN
Medical Physician Assistant	363AM0700X	PA3827	KY	Yes

Addresses

Primary practice location

475 N Highway 25 W Ste 100
Williamsburg, KY 40769-1576

Mailing address

PO Box 247
Jellico, TN 37762-0247

Other providers in Williamsburg, KY

Ruhul Ahmed Choudhury, MD
Elizabeth Rice Christopher, D.C.
Terry Matthew Christopher, D.C.
Rebekah Virginia Elaine Cloud, APRN
Sarah Patricia Cloud
Robert Wayne Cooper, M.D.
Corbin Cardiology & Internal Medicine, Inc.
Ila Corder, PTA
Corner Prescription Shoppe Inc
Michael C Culver, DVM

All providers in Williamsburg, KY · Medical Physician Assistant in Kentucky

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.