Healthcare Provider Details

I. General information

NPI: 1669637831
Provider Name (Legal Business Name): CAROL LYNN COPELIN RN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2008
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 W WALKER ST
BRECKENRIDGE TX
76424
US

IV. Provider business mailing address

725 PATE ST
ALBANY TX
76430-3225
US

V. Phone/Fax

Practice location:
  • Phone: 254-559-7215
  • Fax: 325-893-4035
Mailing address:
  • Phone: 257-622-4473
  • Fax: 325-893-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP117604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: