Provider Demographics
NPI:1760575179
Name:COPE, STEPHANIE CLAIRE (CPNP/PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CLAIRE
Last Name:COPE
Suffix:
Gender:F
Credentials:CPNP/PHD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:CLAIRE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP/PHD
Mailing Address - Street 1:5318 RIVIERA LANE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:937-830-0686
Mailing Address - Fax:325-747-2047
Practice Address - Street 1:225 N. BEAUREGARD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903
Practice Address - Country:US
Practice Address - Phone:325-747-3168
Practice Address - Fax:325-747-2047
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125780363LP0200X
OHNP08195, RN304751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6V6415Medicaid
OH000000585420OtherANTHEM BCBS OHIO
OH2643661Medicaid
OH000000585420OtherANTHEM
OH421534506123OtherCARESOURCE
OH421534506123OtherCARESOURCE