Provider Demographics
NPI:1598388456
Name:KOPP, ELLYN BAKER (APRN, CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:ELLYN
Middle Name:BAKER
Last Name:KOPP
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 MARQUITA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6116
Mailing Address - Country:US
Mailing Address - Phone:214-289-0178
Mailing Address - Fax:
Practice Address - Street 1:7859 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-5605
Practice Address - Country:US
Practice Address - Phone:214-369-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145813363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics