Provider Demographics
NPI:1568897452
Name:TEKOPPEL, ALIVIA M (NP-C)
Entity Type:Individual
Prefix:
First Name:ALIVIA
Middle Name:M
Last Name:TEKOPPEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W BUENA VISTA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5191
Mailing Address - Country:US
Mailing Address - Phone:812-429-1520
Mailing Address - Fax:
Practice Address - Street 1:1202 W BUENA VISTA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5191
Practice Address - Country:US
Practice Address - Phone:812-429-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004616A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner