Provider Demographics
NPI:1043033509
Name:COPP, LESLIE B (FNP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:B
Last Name:COPP
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562-1114
Mailing Address - Country:US
Mailing Address - Phone:812-699-8169
Mailing Address - Fax:
Practice Address - Street 1:1600 A ST NE STE 9
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-1612
Practice Address - Country:US
Practice Address - Phone:812-847-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015951A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner