Provider Demographics
NPI:1457654865
Name:KOOPS, JANET KAY
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:KAY
Last Name:KOOPS
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:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:DOWNS
Mailing Address - State:KS
Mailing Address - Zip Code:67437-0174
Mailing Address - Country:US
Mailing Address - Phone:785-454-6255
Mailing Address - Fax:785-454-6315
Practice Address - Street 1:709 COMMERCIAL ST.
Practice Address - Street 2:
Practice Address - City:DOWNS
Practice Address - State:KS
Practice Address - Zip Code:67437-0174
Practice Address - Country:US
Practice Address - Phone:785-454-6255
Practice Address - Fax:785-454-6315
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-071-002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100291940AMedicaid
KS1363OtherBC BS
KS1363OtherBC BS