Provider Demographics
NPI:1225077563
Name:COPELAND, KELLI L (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:L
Last Name:COPELAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:DR
Other - First Name:KELLI
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328A BARTON RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2725
Mailing Address - Country:US
Mailing Address - Phone:856-810-9403
Mailing Address - Fax:
Practice Address - Street 1:328A BARTON RUN BLVD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2725
Practice Address - Country:US
Practice Address - Phone:856-810-9403
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant