Provider Demographics
NPI:1205264397
Name:COPELAND, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 OLD MCMINNVILLE ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:TN
Mailing Address - Zip Code:38585-3200
Mailing Address - Country:US
Mailing Address - Phone:931-946-2438
Mailing Address - Fax:931-946-7106
Practice Address - Street 1:907 OLD MCMINNVILLE ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:TN
Practice Address - Zip Code:38585-3200
Practice Address - Country:US
Practice Address - Phone:931-946-2438
Practice Address - Fax:931-946-7106
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000165936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse