Provider Demographics
NPI:1821562562
Name:COPELAND, KERRI LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:COPELAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9285 PINE WALK PASS
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8584
Mailing Address - Country:US
Mailing Address - Phone:810-614-1420
Mailing Address - Fax:
Practice Address - Street 1:9285 PINE WALK PASS
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8584
Practice Address - Country:US
Practice Address - Phone:810-614-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily