Healthcare Provider Details

I. General information

NPI: 1639082191
Provider Name (Legal Business Name): BRANDIE KOPSAS-KINGSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5187
US

IV. Provider business mailing address

19400 IRIS CT
NOBLESVILLE IN
46060-8387
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number28197088A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: