Provider Demographics
NPI:1720859192
Name:COPLEY, KELLEY (RN, MT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:COPLEY
Suffix:
Gender:F
Credentials:RN, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25964
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824-1964
Mailing Address - Country:US
Mailing Address - Phone:340-332-1000
Mailing Address - Fax:
Practice Address - Street 1:5001 CHANDLERS WHARF STE 6
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-3621
Practice Address - Country:US
Practice Address - Phone:340-332-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-38379-1L225700000X
VI12177163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist