Provider Demographics
NPI:1326538315
Name:COPELAND, JASON BRIAN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:BRIAN
Last Name:COPELAND
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4443 MARS HILL RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-1918
Mailing Address - Country:US
Mailing Address - Phone:601-479-9760
Mailing Address - Fax:
Practice Address - Street 1:1017 W BEACON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3218
Practice Address - Country:US
Practice Address - Phone:769-200-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily