Healthcare Provider Details

I. General information

NPI: 1083022529
Provider Name (Legal Business Name): CANDACE LYNN KOOPMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY RD
FLORENCE KY
41042-4895
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-5125
  • Fax: 859-212-5099
Mailing address:
  • Phone: 859-212-5125
  • Fax: 859-212-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3011668
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.345067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: