Healthcare Provider Details

I. General information

NPI: 1053746867
Provider Name (Legal Business Name): ROBERT KOPEC DNP, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 N 26TH ST STE 1A
TACOMA WA
98407-2406
US

IV. Provider business mailing address

4009 BRIDGEPORT WAY W SUITE 1A
UNIVERSITY PLACE WA
98466-4326
US

V. Phone/Fax

Practice location:
  • Phone: 253-503-6761
  • Fax:
Mailing address:
  • Phone: 253-503-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60411730
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: