Provider Demographics
NPI:1083057673
Name:COPHER, PAMELA ELLEN (NP-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELLEN
Last Name:COPHER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MEDICAL CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-784-6641
Mailing Address - Fax:606-780-2374
Practice Address - Street 1:234 MEDICAL CIR
Practice Address - Street 2:SUITE1
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1194
Practice Address - Country:US
Practice Address - Phone:606-784-6641
Practice Address - Fax:606-780-2374
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007953363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007953OtherSTATE NP-C
KYK088110Medicare PIN