Healthcare Provider Details

I. General information

NPI: 1881464345
Provider Name (Legal Business Name): ALLISON CHLOE COPENHAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMALIA DR
BUCKHANNON WV
26201-2276
US

IV. Provider business mailing address

PO BOX 795
MORGANTOWN WV
26507-0795
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-2000
  • Fax: 304-473-2057
Mailing address:
  • Phone: 304-473-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3255
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: