Provider Demographics
NPI:1538557467
Name:COPPEDGE, MALIKA (APRN)
Entity type:Individual
Prefix:
First Name:MALIKA
Middle Name:
Last Name:COPPEDGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 RENAISSANCE DR
Mailing Address - Street 2:STE C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6751
Mailing Address - Country:US
Mailing Address - Phone:702-876-0350
Mailing Address - Fax:702-876-1090
Practice Address - Street 1:2255 RENAISSANCE DR
Practice Address - Street 2:STE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6751
Practice Address - Country:US
Practice Address - Phone:702-876-0350
Practice Address - Fax:702-876-1090
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001769363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN001769OtherNV APRN LICENSE