Provider Demographics
NPI:1558822478
Name:COPELAND, KYRA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KYRA
Middle Name:MARIE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KYRA
Other - Middle Name:MARIE
Other - Last Name:KNOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6958
Mailing Address - Country:US
Mailing Address - Phone:419-725-6631
Mailing Address - Fax:
Practice Address - Street 1:115 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6958
Practice Address - Country:US
Practice Address - Phone:419-725-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse