Healthcare Provider Details

I. General information

NPI: 1568897452
Provider Name (Legal Business Name): ALIVIA M TEKOPPEL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 HIGHWAY 62 E BLDG 120
MOUNT VERNON IN
47620-9682
US

IV. Provider business mailing address

801 FELSTEAD RD
EVANSVILLE IN
47712-3637
US

V. Phone/Fax

Practice location:
  • Phone: 812-307-2336
  • Fax:
Mailing address:
  • Phone: 812-490-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004616A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71004616A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: