MEDICARE: DANIELLE COOPER 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	363AS0400X	Surgical Physician Assistant	50.009895RX	OH

General Provider Information

NPI Number	:	1457216392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE COOPER PA-C

Provider Business Mailing Address
First Line	:	3700 SOUTHERN BLVD STE 300
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1265
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 SOUTHERN BLVD STE 300
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1265
Country	:	US
Telephone Number	:	937-643-9299
Fax Number	:

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

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ DANIELLE COOPER PA-C” Practice Location

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