Provider Demographics
NPI:1225489818
Name:COPELAND, BILLY WAYNE
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:WAYNE
Last Name:COPELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 N MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3029
Mailing Address - Country:US
Mailing Address - Phone:405-275-7214
Mailing Address - Fax:
Practice Address - Street 1:2208 N MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3029
Practice Address - Country:US
Practice Address - Phone:405-275-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator