MEDICARE: CAYLIE MARIE COUPLAND PA-C

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	50.007217RX	OH

General Provider Information

NPI Number	:	1417533696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAYLIE MARIE COUPLAND PA-C

Provider Business Mailing Address
First Line	:	7249 LIBERTY WAY STE 100
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1704
Country	:	US
Telephone Number	:	513-770-3263
Fax Number	:

Provider Business Practice Location Address
First Line	:	7249 LIBERTY WAY STE 100
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1704
Country	:	US
Telephone Number	:	513-770-3263
Fax Number	:

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

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	01/22/2025

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