Cheyenna Lynne Kopacz, DNP FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

227570 Issued in AZ

Practice address

#1098 2501 W Happy Valley Rd
Suite 4
Phoenix, AZ 85085

Phone

(602) 489-4958

NPI assigned

Jun 14, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Cheyenna Lynne Kawal Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Rhad Health Care LLC

  • Family Medicine Physician
  • Peoria, AZ
  • NPI 1780339721
  Medicare reassignment NPD
• Devoted Medical Group Professional Corporation

  • Primary Care Clinic/Center
  • Pembroke Pines, FL
  • NPI 1245838168

  AZ

  Medicare reassignment NPD
• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1386204097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#1098 2501 W HAPPY VALLEY RD",
            "address_2": "SUITE 4",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85085",
            "telephone_number": "602-489-4958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#1098 2501 W HAPPY VALLEY RD",
            "address_2": "SUITE 4",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85085",
            "telephone_number": "602-489-4958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPACZ",
        "first_name": "CHEYENNA",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "DNP FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-14",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "227570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z229839",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "533013",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHEYENNA",
            "last_name": "KAWAL",
            "middle_name": "LYNNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Barbara Koopman
• Celyna Koopmann, PHARMD
• Ravi Koopot, M.D.
• Jeffrey Howard Kootman, DMD
• David Vincent Kop, DDS
• Tammy Kopelman, MD
• Jessica Kopesky, COTA/L
• Walter Edwin Koppenbrink III, M.D.
• Sarah Koppenhoefer-Little, OTR/L
• Sameet Koppikar, DDS

• Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.

Verify at the official NPI Registry.