Provider Demographics
NPI:1134155245
Name:COOPER, ANGELA HUCKS (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:HUCKS
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-1440
Mailing Address - Country:US
Mailing Address - Phone:843-433-8010
Mailing Address - Fax:
Practice Address - Street 1:618 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-3034
Practice Address - Country:US
Practice Address - Phone:843-433-8010
Practice Address - Fax:843-433-8692
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC888363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7153OtherMEDICARE GROUP NUMBER
SCGP4377OtherMEDICAID GROUP NUMBER
SC0209PAMedicaid
SC0209PAMedicaid
SCAA01947153Medicare PIN