Active NPI
Susan Diane Koepp, NP
- Family Nurse Practitioner
- Oriental, NC
National Provider Identifier
1174567556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 0200684
- Practice address
- 1101 Broad Street Ext
Oriental, NC 28571-9790 - Phone
- (252) 249-2220
- Fax
- (252) 249-2275
- NPI assigned
- Jun 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0200684 | NC | Primary |
Addresses
Primary practice location
1101 Broad Street Ext
Oriental, NC 28571-9790
Mailing address
PO Box 383
1101 Broad St Ext
Oriental, NC 28571-9790
Phone (252) 249-2220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0200684 | NC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pamlico Regional Medical Center PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Neuromusculoskeletal Medicine & OMM Physician
- Bayboro, NC
- NPI 1437246204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412035200000",
"number": "1174567556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 383",
"address_2": "1101 BROAD ST EXT",
"city": "ORIENTAL",
"state": "NC",
"postal_code": "285719790",
"telephone_number": "252-249-2220",
"fax_number": "252-249-2275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 BROAD STREET EXT",
"city": "ORIENTAL",
"state": "NC",
"postal_code": "285719790",
"telephone_number": "252-249-2220",
"fax_number": "252-249-2275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEPP",
"first_name": "SUSAN",
"middle_name": "DIANE",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-15",
"last_updated": "2014-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NC",
"license": "0200684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oriental, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.