Provider Demographics
NPI:1790270908
Name:COPPENGER, JONATHAN (NP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:COPPENGER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 MIDDLE CREEK RD STE 270
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3052
Mailing Address - Country:US
Mailing Address - Phone:865-365-3074
Mailing Address - Fax:
Practice Address - Street 1:1130 MIDDLE CREEK RD STE 270
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3052
Practice Address - Country:US
Practice Address - Phone:865-365-3074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily