Provider Demographics
NPI:1023622560
Name:KOPPEL, KAITLIN ANNE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANNE
Last Name:KOPPEL
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 BANGOR RD
Mailing Address - Street 2:
Mailing Address - City:LINNEUS
Mailing Address - State:ME
Mailing Address - Zip Code:04730-4613
Mailing Address - Country:US
Mailing Address - Phone:207-694-2225
Mailing Address - Fax:
Practice Address - Street 1:22 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1844
Practice Address - Country:US
Practice Address - Phone:207-532-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily