Provider Demographics
NPI:1457804056
Name:COPPER, ABIGAIL L (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:L
Last Name:COPPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:L
Other - Last Name:TENNANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2449 ROSS MILLVILLE RD STE 270
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-8952
Mailing Address - Country:US
Mailing Address - Phone:513-738-3900
Mailing Address - Fax:513-738-7283
Practice Address - Street 1:2449 ROSS MILLVILLE RD STE 270
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8952
Practice Address - Country:US
Practice Address - Phone:513-738-3900
Practice Address - Fax:513-738-7283
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0209350Medicaid