Provider Demographics
NPI:1013973551
Name:COPPOCK, STEVEN FLOYD (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:FLOYD
Last Name:COPPOCK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70727
Mailing Address - Country:US
Mailing Address - Phone:225-665-7409
Mailing Address - Fax:
Practice Address - Street 1:8852 LOCKHART RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:225-665-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-05-29
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-05-22
Provider Licenses
StateLicense IDTaxonomies
LAAP02513367500000X
LAM036963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse