Provider Demographics
NPI:1912896945
Name:KOOPLICAT, ROSHIN MATHEW (PMHNP)
Entity type:Individual
Prefix:
First Name:ROSHIN
Middle Name:MATHEW
Last Name:KOOPLICAT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 PRECISION DR UNIT F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4541
Mailing Address - Country:US
Mailing Address - Phone:404-494-6269
Mailing Address - Fax:
Practice Address - Street 1:1300 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5989
Practice Address - Country:US
Practice Address - Phone:970-686-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000749363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health