Provider Demographics
NPI:1265744148
Name:COPLEY HARRIS, MEGAN LARISSA (DO)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LARISSA
Last Name:COPLEY HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LARISSA
Other - Last Name:COPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-430-3500
Mailing Address - Fax:606-218-4697
Practice Address - Street 1:911 BYPASS RD BLDG A
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-430-3500
Practice Address - Fax:606-218-4697
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116022973207R00000X
KY03601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100245490Medicaid
KY7100245490Medicaid