Healthcare Provider Details

I. General information

NPI: 1073236485
Provider Name (Legal Business Name): JENNIE KAY COPPINGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MEDIC LN STE B
ALVIN TX
77511-5894
US

IV. Provider business mailing address

177 SMITH HOLLOW RD
MCMINNVILLE TN
37110-3807
US

V. Phone/Fax

Practice location:
  • Phone: 281-331-2062
  • Fax:
Mailing address:
  • Phone: 931-743-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64790
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16353
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: