Basic Information
| Provider Information | |||||||||
| NPI: | 1083057673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPHER | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 MEDICAL CIR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067846641 | ||||||||
| FaxNumber: | 6067802374 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 MEDICAL CIR | ||||||||
| Address2: | SUITE1 | ||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067846641 | ||||||||
| FaxNumber: | 6067802374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2013 | ||||||||
| LastUpdateDate: | 04/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3007953 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3007953 | 01 | KY | STATE NP-C | OTHER |