Healthcare Provider Details

I. General information

NPI: 1013973551
Provider Name (Legal Business Name): STEVEN FLOYD COPPOCK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 05/22/2008

III. Provider practice location address

8852 LOCKHART RD
DENHAM SPRINGS LA
70726
US

IV. Provider business mailing address

PO BOX 1071
DENHAM SPRINGS LA
70727
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-7409
  • Fax:
Mailing address:
  • Phone: 225-665-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP02513
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberM036963
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: