Healthcare Provider Details

I. General information

NPI: 1477354140
Provider Name (Legal Business Name): KIERSTIN SOPHIA COUP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST UNIT B
TOLEDO OH
43608-2603
US

IV. Provider business mailing address

2213 CHERRY ST UNIT B
TOLEDO OH
43608-2603
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-5155
  • Fax: 419-251-5160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010588RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA066486
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: