Healthcare Provider Details

I. General information

NPI: 1528858057
Provider Name (Legal Business Name): ABIGAIL JANE COOPER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WASHINGTON ST STE 150
MEDINA OH
44256-3336
US

IV. Provider business mailing address

831 TOWNSHIP ROAD 462
NOVA OH
44859-9709
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-2106
  • Fax: 330-764-9712
Mailing address:
  • Phone: 330-416-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0039123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: