Provider Demographics
NPI:1437135241
Name:KOPPEIS MCTEARNEN, JULIE M (FNP,BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:KOPPEIS MCTEARNEN
Suffix:
Gender:F
Credentials:FNP,BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:KOPPEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-756-7844
Mailing Address - Fax:573-454-2251
Practice Address - Street 1:1105 W LIBERTY ST
Practice Address - Street 2:SUITE 4050
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1921
Practice Address - Country:US
Practice Address - Phone:573-756-7844
Practice Address - Fax:573-454-2251
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO153843363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ43297Medicare UPIN
MOQ43297Medicare UPIN
MO427207709Medicaid