Healthcare Provider Details

I. General information

NPI: 1285998617
Provider Name (Legal Business Name): KOEPP KARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W 13TH AVE
COVINGTON LA
70433-2407
US

IV. Provider business mailing address

915 W 13TH AVE
COVINGTON LA
70433-2407
US

V. Phone/Fax

Practice location:
  • Phone: 985-515-9446
  • Fax:
Mailing address:
  • Phone: 985-515-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberF0612200
License Number StateLA

VIII. Authorized Official

Name: MRS. BONNIE ANN KOEPP
Title or Position: MANAGER
Credential: FNP-C
Phone: 985-515-9446