Healthcare Provider Details

I. General information

NPI: 1457216392
Provider Name (Legal Business Name): DANIELLE COOPER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTHERN BLVD STE 300
KETTERING OH
45429-1265
US

IV. Provider business mailing address

3700 SOUTHERN BLVD STE 300
KETTERING OH
45429-1265
US

V. Phone/Fax

Practice location:
  • Phone: 937-643-9299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.009895RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: