Provider Demographics
NPI:1316306392
Name:KOPADDY, LANETTE
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:
Last Name:KOPADDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 THURMAN DR
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-3203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 THURMAN DR
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572-3203
Practice Address - Country:US
Practice Address - Phone:580-514-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator