Provider Demographics
NPI:1326578600
Name:COPES, CAITLIN (FNP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:COPES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 HIGHWAY 603
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-7709
Mailing Address - Country:US
Mailing Address - Phone:601-218-9697
Mailing Address - Fax:
Practice Address - Street 1:2080 S FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5328
Practice Address - Country:US
Practice Address - Phone:601-883-6304
Practice Address - Fax:601-883-6325
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily