Kathryn Marie Copak, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

28116773A Issued in IN

Practice address

1121 S Indiana Ave
Crown Point, IN 46307-8516

Phone

(219) 663-5413

Fax

(219) 663-5491

NPI assigned

Mar 12, 2008

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205280000000",
    "number": "1912178443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 S INDIANA AVE",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078516",
            "telephone_number": "219-663-5413",
            "fax_number": "219-663-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 S INDIANA AVE",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078516",
            "telephone_number": "219-663-5413",
            "fax_number": "219-663-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPAK",
        "first_name": "KATHRYN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-12",
        "last_updated": "2008-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28116773A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200449790",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Registered Nurse in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.