Healthcare Provider Details

I. General information

NPI: 1740291947
Provider Name (Legal Business Name): KRISTINA M COPELAND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 14TH ST
MERIDIAN MS
39301-4040
US

IV. Provider business mailing address

9331COLLINSVILLE LAKE DR
COLLINSVILLE MS
39325
US

V. Phone/Fax

Practice location:
  • Phone: 601-553-6000
  • Fax: 601-553-6115
Mailing address:
  • Phone: 601-626-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR853576
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: