Individual
KELLIE LYNN KOPP
Active
Individual
KELLIE LYNN KOPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1666
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12658284
CAQH
—
05
—
1326462185
—
NV
Enumeration date
02/13/2014
Last updated
01/11/2021
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