Provider Demographics
NPI:1881392538
Name:KOPTER-MEREDITH, NEUNG R (DNP)
Entity type:Individual
Prefix:
First Name:NEUNG
Middle Name:R
Last Name:KOPTER-MEREDITH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:KOPTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:901 N AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-2863
Mailing Address - Country:US
Mailing Address - Phone:606-203-5657
Mailing Address - Fax:
Practice Address - Street 1:100 LAKE TRAVERSE DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-7046
Practice Address - Country:US
Practice Address - Phone:605-698-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily