Kelcey Raye Cooper, PA-C, ATC
Individual provider Active NPI Physician Assistant · Olive Branch, MS
NPI 1922515923 · NPPES record last updated May 27, 2025
Key facts
- NPI
- 1922515923
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00617 (MS)
- Practice address
- 4250 Bethel Rd
Olive Branch, MS 38654-8737 - Phone
- (901) 516-1290
- Fax
- (901) 516-1220
- NPI assigned
- Dec 29, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Methodist Inpatient Physicians LLC
Practice addresses (Care Compare)
4250 Bethel Rd
Olive Branch, MS 38654-8737
Phone (901) 516-1290
Hospital & facility affiliations
- Methodist Healthcare - Olive Branch Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, TN
- 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 |
|---|---|---|---|---|
| I20220204000394 | MS | Practitioner - Physician Assistant | 7416340989 | Reassigns benefits to 1 organization |
| I20220221000160 | TN | Practitioner - Physician Assistant | 7416340989 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4118 | TN | MD | Pharmacist |
| PA00617 | MS | MD | Physician Assistant |
Interoperability endpoints
- kcooper44218@mlh.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Physician Assistant | 363A00000X | PA00617 | MS | Yes |
Addresses
Primary practice location
4250 Bethel Rd
Olive Branch, MS 38654-8737
Mailing address
1211 Union Ave Ste 330
Memphis, TN 38104-6655
Other practice location 1
7691 Poplar Ave
Germantown, TN 38138-3904
Phone (901) 516-1290
Other providers in Olive Branch, MS
- Greene Berry Colvin IV
- Alisha Gholston Comer
- Comprehensive Stafffing Services
- Confident Living LLC
- Julia Conner-Mendez
- Cornerstone Health & Wellness Clinic of Tennessee
- Cornerstone HME
- Cornerstone Hospice Palliative Care, LLC
- Cornerstone Women'S Center, PLLC
- Marena Locke Counce
All providers in Olive Branch, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2025. 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.