Healthcare Provider Details

I. General information

NPI: 1346721735
Provider Name (Legal Business Name): ROBERT KOPE REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 01/21/2023
Certification Date: 01/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 AIRPORT BLVD
AUSTIN TX
78702-3152
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3009
  • Fax:
Mailing address:
  • Phone: 512-445-7787
  • Fax: 512-440-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number210945
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1090955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: