Provider Demographics
NPI:1215491501
Name:KOEPP, JACQUELYN MARGARET (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MARGARET
Last Name:KOEPP
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 STATE ROUTE 97
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-7347
Mailing Address - Country:US
Mailing Address - Phone:270-804-0872
Mailing Address - Fax:
Practice Address - Street 1:2670 NEW HOLT RD STE C
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7506
Practice Address - Country:US
Practice Address - Phone:270-575-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily