Provider Demographics
NPI:1114400090
Name:COPELAND, TYLER (FNP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:COPELAND
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:1307 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FRIONA
Practice Address - State:TX
Practice Address - Zip Code:79035-1121
Practice Address - Country:US
Practice Address - Phone:806-250-2754
Practice Address - Fax:806-250-2801
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX822444163W00000X
TXAP138440363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily