Healthcare Provider Details

I. General information

NPI: 1043033509
Provider Name (Legal Business Name): LESLIE B COPP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 04/15/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 A ST NE STE 9
LINTON IN
47441-1612
US

IV. Provider business mailing address

1600 A ST NE STE 9
LINTON IN
47441-1612
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-7005
  • Fax: 812-847-5309
Mailing address:
  • Phone: 812-847-7005
  • Fax: 812-847-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71015951A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: