Provider Demographics
NPI:1356686141
Name:ROPER, ERICA COOLER (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:COOLER
Last Name:ROPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LINDSEY
Other - Last Name:COOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5454
Mailing Address - Country:US
Mailing Address - Phone:843-522-7843
Mailing Address - Fax:843-522-5945
Practice Address - Street 1:4818 BLUFFTON PKWY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4602
Practice Address - Country:US
Practice Address - Phone:843-706-0600
Practice Address - Fax:833-916-2116
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1869363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1668PAMedicaid
SCSC03996830OtherMEDICARE PTAN
SC1668PAMedicaid