MEDICARE: MISTY COPELAND RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1214438	TX

General Provider Information

NPI Number	:	1245164383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY COPELAND RN

Provider Business Mailing Address
First Line	:	855 FOREST ST
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	76227-1539
Country	:	US
Telephone Number	:	817-733-2507
Fax Number	:

Provider Business Practice Location Address
First Line	:	7460 WARREN PKWY
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-4169
Country	:	US
Telephone Number	:	817-733-2507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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