Healthcare Provider Details

I. General information

NPI: 1275973539
Provider Name (Legal Business Name): ROSEMARY TAKYI KOEPPEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSEMARY TAKYI OWUSU MD

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 E MAIN ST
OAK GROVE LA
71263-2500
US

IV. Provider business mailing address

708 E MAIN ST
OAK GROVE LA
71263-2500
US

V. Phone/Fax

Practice location:
  • Phone: 318-428-3200
  • Fax: 217-245-6775
Mailing address:
  • Phone: 318-428-3200
  • Fax: 318-428-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number352115
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: