Provider Demographics
NPI:1477991784
Name:KOPF, KACINDRA JO (APRN)
Entity Type:Individual
Prefix:MS
First Name:KACINDRA
Middle Name:JO
Last Name:KOPF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KACINDRA
Other - Middle Name:JO
Other - Last Name:OLBERDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:304 E DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1830
Mailing Address - Country:US
Mailing Address - Phone:402-336-4222
Mailing Address - Fax:402-336-4228
Practice Address - Street 1:304 E DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763
Practice Address - Country:US
Practice Address - Phone:402-336-4222
Practice Address - Fax:402-336-4228
Is Sole Proprietor?:No
Enumeration Date:2013-06-08
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111504363L00000X, 363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025080400Medicaid
NE147991784Medicare PIN
NE147991784Medicaid