1538613336 NPI number — MS. KIMBERLEE JOANNE COPPELLI PA

Table of content: MS. KIMBERLEE JOANNE COPPELLI PA (NPI 1538613336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538613336 NPI number — MS. KIMBERLEE JOANNE COPPELLI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPPELLI
Provider First Name:
KIMBERLEE
Provider Middle Name:
JOANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538613336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63160-0352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-514-3913
Provider Business Mailing Address Fax Number:
314-514-3534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14532 S OUTER 40 RD
Provider Second Line Business Practice Location Address:
DEPT ORTHOPAEDIC SURG, DEPT STE 200
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-5705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-514-3913
Provider Business Practice Location Address Fax Number:
314-514-3534
Provider Enumeration Date:
08/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  2018033076 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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