Provider Demographics
NPI:1003499724
Name:COPE, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:COPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 WELCHLAND CAMP RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:TN
Mailing Address - Zip Code:38585-5404
Mailing Address - Country:US
Mailing Address - Phone:931-808-8128
Mailing Address - Fax:
Practice Address - Street 1:1685 PAUL CONN PARKWAY NE
Practice Address - Street 2:ROOM 102
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:931-808-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program