Kopp, Keely Egan

Kopp, Keely Egan is an individual health care provider with primary practice located at 2180 Main St , Wailuku HI 96793-1625. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Kopp, Keely Egan can be contacted via phone (808) 242-6464.

Contact Information

Primary practice address
2180 Main St Wailuku HI 96793-1625
Phone: (808) 242-6464
Fax: (808) 242-4292
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA001129 Maine
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X AMD-522 Hawaii

Profile Details

NPI number 1356506190
LBN Legal business name Kopp, Keely Egan
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2008
Last updated Oct 22nd, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356506190 NPPES
Maine MEDICAID 433005199
Maine MEDICAID 30336793

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