MEDICARE: SAMANTHA KOPP PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.008767RX	OH
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1184340267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA KOPP PA

Provider Business Mailing Address
First Line	:	7676 BEAVER CREEK DR
Second Line	:
City	:	MOUNT JULIET
State	:	OH
Zip	:	37122
Country	:	US
Telephone Number	:	440-320-5714
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 JAMES ROBERTSON PKWY
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37201-1202
Country	:	US
Telephone Number	:	440-320-5714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	04/07/2025

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Directions to “ SAMANTHA KOPP PA” Practice Location

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