Healthcare Provider Details

I. General information

NPI: 1356264303
Provider Name (Legal Business Name): SHELBY COOPER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 FOUNTAIN CT STE 180
LEXINGTON KY
40509-1896
US

IV. Provider business mailing address

230 FOUNTAIN CT STE 180
LEXINGTON KY
40509-1896
US

V. Phone/Fax

Practice location:
  • Phone: 859-952-1008
  • Fax:
Mailing address:
  • Phone: 859-592-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2359
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: