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General NPI Number Information
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NPI Number | 1043883259
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Entity Type | Individual
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Provider Name | REBECCA SUE KOOPMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/24/2021
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 705 FAIRGROUND RD
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City | SCOTTSBURG
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State | IN
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Zip | 47170-6778
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Country | US
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Telephone | 812-752-0165
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 CAMPUS PL
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City | LOUISVILLE
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State | KY
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Zip | 40299-2308
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Country | US
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Telephone | 502-253-4924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9114971
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10004445A
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License Number State | IN
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