Provider Demographics
NPI:1891781670
Name:KOPRA, RONDA J (PA-C, MSM)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:J
Last Name:KOPRA
Suffix:
Gender:F
Credentials:PA-C, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LEBANON RD
Mailing Address - Street 2:VAMC GEC SERVICE
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1237
Mailing Address - Country:US
Mailing Address - Phone:615-225-9786
Mailing Address - Fax:615-225-3793
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:VAMC GEC SERVICE
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1237
Practice Address - Country:US
Practice Address - Phone:615-225-9786
Practice Address - Fax:615-225-3793
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1221363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ37164Medicare UPIN
TN202I970268Medicare PIN
TN3663267Medicare ID - Type Unspecified