Provider Demographics
NPI:1275279937
Name:COOPER, COURTNEY DANIELLE (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DANIELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DANIELLE
Other - Last Name:AMEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-374-3526
Mailing Address - Fax:
Practice Address - Street 1:305 CLAY ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1059
Practice Address - Country:US
Practice Address - Phone:304-447-2038
Practice Address - Fax:304-447-3990
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant