Provider Demographics
NPI:1669496279
Name:COPENHAVER, CAROLE F (NP)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:F
Last Name:COPENHAVER
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 1:120 HOSPITAL DR
Mailing Address - Street 2:SIUTE 240
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5279
Mailing Address - Country:US
Mailing Address - Phone:865-471-0312
Mailing Address - Fax:865-475-2802
Practice Address - Street 1:6350 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8605
Practice Address - Country:US
Practice Address - Phone:865-471-0312
Practice Address - Fax:865-475-2802
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics