Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lisa Koop

Individual provider Certified Registered Nurse Anesthetist · NPI 1265160881

Lisa Koop is a Certified Registered Nurse Anesthetist (CRNA) in Fort Wayne, Indiana. Qualified in 2022, 4 years ago. Practices with Anesthesia Dynamics LLC, a 880-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
4
Licensed in
IN
In the registry since
2022
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Practice location Address checks out

5050 N Clinton St
Fort Wayne, IN 46825-5886
Phone: (260) 484-8551
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 28193681A (IN)

Record details

NPI number1265160881
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 11, 2022
Last updated in NPPESAugust 11, 2022
Certification dateAugust 11, 2022
Mailing address5052 N Clinton St, Fort Wayne, IN 46825-5822

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Anesthesia Dynamics Llc — 880 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Fort Wayne