Provider Demographics
NPI:1053746867
Name:KOPEC, ROBERT (DNP, ARNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KOPEC
Suffix:
Gender:M
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4326
Mailing Address - Country:US
Mailing Address - Phone:253-503-6761
Mailing Address - Fax:
Practice Address - Street 1:5702 N 26TH ST STE 1A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2406
Practice Address - Country:US
Practice Address - Phone:253-503-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60411730363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health