MEDICARE: MRS. KIMBERLY M. KOPFMAN CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD.5538	OH
2	163W00000X	Registered Nurse	RN.399668	OH
3	174N00000X	Lactation Consultant (Non-RN)	ALPP-3267	OH
4	363LP0200X	Pediatric Nurse Practitioner	COA.18068-NP	OH
5	363LP0200X	Pediatric Nurse Practitioner	10868-NP	OH

General Provider Information

NPI Number	:	1942570080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY M. KOPFMAN CPNP

Provider Business Mailing Address
First Line	:	3300 RIVERSIDE DRIVE, SUITE 200
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1738
Country	:	US
Telephone Number	:	614-459-4200
Fax Number	:	614-459-1589

Provider Business Practice Location Address
First Line	:	3300 RIVERSIDE DRIVE, SUITE 200
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1738
Country	:	US
Telephone Number	:	614-459-4200
Fax Number	:	614-459-1589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	03/19/2020

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