MEDICARE: AMY J COOPER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0029440	OH

General Provider Information

NPI Number	:	1043984289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY J COOPER NP

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 DELAWARE AVE
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6416
Country	:	US
Telephone Number	:	740-692-4436
Fax Number	:	740-383-7067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	01/05/2026

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