Basic Information
| Provider Information | |||||||||
| NPI: | 1457695124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPASS | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 277 NE ROAD RUNNER DR | ||||||||
| Address2: | |||||||||
| City: | FLETCHER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735411146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806471004 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3401 W GORE BLVD | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803558620 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | 87794 | OK | Y | Nursing Service Providers | Registered Nurse | Lactation Consultant |
No ID Information.