| Doctor Name: | PATRICIA ROSE KOEPL |
| NPI Number: | 1124395900 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PMHNP |
| License Number: | 23649A |
| Business Practice Address: | 1032 S Bridge Way Pl Suite 100 Eagle, ID - 836166099 |
| Business Phone Number: | 2082460123 |
| Business Fax Number: | 2082460125 |
| Mailing Address: | 1032 S Bridge Way Pl, Suite 100 EAGLE |
| State: | ID |
| Postal Code: | 836166099 |
| Phone Number: | 2082460123 |
| Fax Number: | 2082460124 |
| NPI Enumeration Date: | 11/22/2011 |
| NPI Last Update Date: | 11/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 23649A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |