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:
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:PO BOX 746071
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6071
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:8564 WINTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4907
Practice Address - Country:US
Practice Address - Phone:513-904-4679
Practice Address - Fax:513-586-0296
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OH50.004877RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0209350Medicaid