Provider Demographics
NPI:1114307303
Name:KOPP, DAWN M (FNP-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:KOPP
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:PO BOX 221273
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1273
Mailing Address - Country:US
Mailing Address - Phone:812-734-0303
Mailing Address - Fax:812-225-5145
Practice Address - Street 1:2086 OLD HIGHWAY 135 NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-4015
Practice Address - Country:US
Practice Address - Phone:812-734-0303
Practice Address - Fax:812-225-5145
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009415363LF0000X
IN28181390A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201305640Medicaid