MEDICARE: DARBY ELISABETH COOPER PA

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	363AM0700X	Medical Physician Assistant	0010-12737	NC
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1053038638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARBY ELISABETH COOPER PA

Provider Business Mailing Address
First Line	:	125 MEDICAL PARK LN STE H
Second Line	:
City	:	MURPHY
State	:	NC
Zip	:	28906-6921
Country	:	US
Telephone Number	:	865-405-9457
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 MEDICAL PARK LN STE H
Second Line	:
City	:	MURPHY
State	:	NC
Zip	:	28906-6921
Country	:	US
Telephone Number	:	828-837-3525
Fax Number	:

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	02/20/2024

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