MEDICARE: YURI J KOPP RN, MSN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	385688	OH
2	363LF0000X	Family Nurse Practitioner	CNP-03229	NM
3	363LF0000X	Family Nurse Practitioner	APRN.CNP.019658	OH

General Provider Information

NPI Number	:	1417395708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YURI J KOPP RN, MSN, NP-C

Provider Business Mailing Address
First Line	:	385 CALLE DE ALEGRA STE A
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3423
Country	:	US
Telephone Number	:	575-526-1105
Fax Number	:	575-524-4266

Provider Business Practice Location Address
First Line	:	3751 DEL REY BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-8526
Country	:	US
Telephone Number	:	575-382-6697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	03/17/2026

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