Provider Demographics
NPI:1972015832
Name:KOPECKY, JEANEE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:JEANEE
Middle Name:
Last Name:KOPECKY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 HIGHWAY 190 APT 1011
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3483
Mailing Address - Country:US
Mailing Address - Phone:985-807-4706
Mailing Address - Fax:
Practice Address - Street 1:2401 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-2582
Practice Address - Country:US
Practice Address - Phone:985-795-2228
Practice Address - Fax:844-883-2537
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09493208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics