Provider Demographics
NPI:1619912979
Name:COPLEY, PATRICIA DEANN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DEANN
Last Name:COPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7635
Mailing Address - Fax:615-469-6505
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-694-1300
Practice Address - Fax:979-694-1313
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074121A207RC0200X, 207RP1001X
TXK2671207RC0200X, 207RP1001X, 207RS0012X
TN34473207RP1001X
CODR.0063855207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096549303Medicaid
TNP00270721OtherRR MEDICARE PIN
TN3859838Medicaid
TN3717547Medicare ID - Type UnspecifiedLEGACY GROUP
TX096549303Medicaid
TN3859838Medicare ID - Type UnspecifiedLEGACY PIN
TXTXB128984Medicare PIN