Provider Demographics
NPI:1609597285
Name:COPELAND, COURTNEY KAY (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KAY
Last Name:COPELAND
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 MICMAC CT
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-6025
Mailing Address - Country:US
Mailing Address - Phone:225-380-6029
Mailing Address - Fax:
Practice Address - Street 1:8739 MICMAC CT
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-6025
Practice Address - Country:US
Practice Address - Phone:225-380-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic