Provider Demographics
NPI:1437239480
Name:COPELAND, AMANDA (RN, CNS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WEDGWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,CNS
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690969364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167474901Medicaid
TX167474901Medicaid
O21895Medicare UPIN