Provider Demographics
NPI:1598476285
Name:KOPP, KASSANDRA (FNP)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:KOPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 W ST ANNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2284
Mailing Address - Country:US
Mailing Address - Phone:480-295-9959
Mailing Address - Fax:
Practice Address - Street 1:5537 W ST ANNE AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2284
Practice Address - Country:US
Practice Address - Phone:480-295-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ281074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily