Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | ARNP9370385 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 20340 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 9370385 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP30007423 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN270748 | GA |
NPI | 1164646659 |
---|---|
Provider Name | Terri Kopp |
First Address | Loganville, GA 30052-4336 |
Second Address | Loganville, GA 30052-4336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 15/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164646659 | NPI- (01) | CA |