Basic Information
| Provider Information | |||||||||
| NPI: | 1437135241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOPPEIS MCTEARNEN | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | FNP,BC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KOPPEIS | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 670 MASON RIDGE CENTER DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737567844 | ||||||||
| FaxNumber: | 5734542251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 W LIBERTY ST | ||||||||
| Address2: | SUITE 4050 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737567844 | ||||||||
| FaxNumber: | 5734542251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 153843 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.