Provider Demographics
NPI:1598970642
Name:KOPRIVA, BRENDA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:KOPRIVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:MELLIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:310 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3716
Mailing Address - Country:US
Mailing Address - Phone:785-462-6184
Mailing Address - Fax:785-460-1490
Practice Address - Street 1:310 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3716
Practice Address - Country:US
Practice Address - Phone:785-462-6184
Practice Address - Fax:785-460-1490
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26100208600000X
KS0433262208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201117420AMedicaid
KS201117420AMedicaid