Provider Demographics
NPI:1134618341
Name:KOEPP, HALEY M (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:HALEY
Middle Name:M
Last Name:KOEPP
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 S NEW BALLAS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8706
Mailing Address - Country:US
Mailing Address - Phone:314-569-1717
Mailing Address - Fax:314-569-0441
Practice Address - Street 1:763 S NEW BALLAS RD STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8706
Practice Address - Country:US
Practice Address - Phone:314-569-1717
Practice Address - Fax:314-569-0441
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018012799363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health