Healthcare Provider Details

I. General information

NPI: 1447240437
Provider Name (Legal Business Name): KATIE E COPELAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 E LOUISE DR SUITE 200
MERIDIAN ID
83642-9351
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-468-5930
  • Fax: 208-463-3044
Mailing address:
  • Phone: 208-381-2222
  • Fax: 208-463-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM8753
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: