Provider Demographics
NPI:1962497263
Name:COPELAND, KEITH LOYD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:LOYD
Last Name:COPELAND
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 398
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:4120 SOUTHWEST FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7339
Practice Address - Country:US
Practice Address - Phone:713-626-8500
Practice Address - Fax:713-626-8560
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX236533367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031051OtherRECERTIFICATION AANA
TX86923UOtherBLUE CROSS BLUE SHIELD
TX81740UOtherBLUE CROSS BLUE SHIELD
LA1501417Medicaid
TXP00379468OtherRAILROAD MEDICARE
031051OtherCRNA
TX83295HMedicare ID - Type Unspecified
TX8D5385Medicare PIN
LA1501417Medicaid