Individual
LEXIE ANN KOOP-SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71014156A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103714156
ANTHEM PTAN
IN
05
—
300082391
—
IN
01
—
815500594
MEDICARE PTAN
IN
Enumeration date
08/29/2022
Last updated
09/13/2024
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