Provider Demographics
NPI:1316458730
Name:KOPPIE, KAREN MICHELLE
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MICHELLE
Last Name:KOPPIE
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 1:1013 HENRY JONES RD
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:LA
Mailing Address - Zip Code:71266-7374
Mailing Address - Country:US
Mailing Address - Phone:318-557-2849
Mailing Address - Fax:
Practice Address - Street 1:1013 HENRY JONES RD
Practice Address - Street 2:
Practice Address - City:PIONEER
Practice Address - State:LA
Practice Address - Zip Code:71266-7374
Practice Address - Country:US
Practice Address - Phone:318-557-2849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily