MEDICARE: JULIE M KOPPEIS MCTEARNEN FNP,BC

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	363LF0000X	Family Nurse Practitioner	153843	MO

General Provider Information

NPI Number	:	1437135241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE M KOPPEIS MCTEARNEN FNP,BC

Provider Business Mailing Address
First Line	:	670 MASON RIDGE CENTER DR
Second Line	:	STE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8573
Country	:	US
Telephone Number	:	573-756-7844
Fax Number	:	573-454-2251

Provider Business Practice Location Address
First Line	:	1105 W LIBERTY ST
Second Line	:	SUITE 4050
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1921
Country	:	US
Telephone Number	:	573-756-7844
Fax Number	:	573-454-2251

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	03/14/2016

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