Provider Demographics
NPI:1184340267
Name:KOPP, SAMANTHA (PA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KOPP
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:DIFRANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7676 BEAVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:OH
Mailing Address - Zip Code:37122
Mailing Address - Country:US
Mailing Address - Phone:440-320-5714
Mailing Address - Fax:
Practice Address - Street 1:200 JAMES ROBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37201-1202
Practice Address - Country:US
Practice Address - Phone:440-320-5714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008767RX363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant