Provider Demographics
NPI:1669637831
Name:COPELIN, CAROL LYNN (RN FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:COPELIN
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Gender:F
Credentials:RN FNP-BC
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Mailing Address - Street 1:725 PATE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-3225
Mailing Address - Country:US
Mailing Address - Phone:257-622-4473
Mailing Address - Fax:325-893-4035
Practice Address - Street 1:2802 W WALKER ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424
Practice Address - Country:US
Practice Address - Phone:254-559-7215
Practice Address - Fax:325-893-4035
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2021-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP117604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200114101Medicaid
TX8F9770Medicare PIN
TXP00769774Medicare PIN
TX8L5172Medicare PIN