Provider Demographics
NPI:1992088199
Name:COOPER, MELISSA LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:STE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-865-8540
Mailing Address - Fax:317-865-8317
Practice Address - Street 1:9001 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7041
Practice Address - Country:US
Practice Address - Phone:219-795-3360
Practice Address - Fax:219-756-6500
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2016-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN99048717A363AS0400X
IN10001330A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233110Medicare PIN