Provider Demographics
NPI:1730499963
Name:COPELAND, JESSIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NRHN REHAB PHYSICIAN SERVICES
Mailing Address - Street 2:105 CORPORATE DRIVE
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-501-5547
Mailing Address - Fax:603-501-5650
Practice Address - Street 1:NRHN REHAB PHYSICIAN SERVICES
Practice Address - Street 2:70 BUTLER STREET
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-501-5547
Practice Address - Fax:603-501-5650
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001250363A00000X
NH0808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075575Medicaid