Healthcare Provider Details

I. General information

NPI: 1912629288
Provider Name (Legal Business Name): TAMMY ELLEN COPELAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 TRICORN RD
DANVILLE WV
25053-7148
US

IV. Provider business mailing address

32 BETH HAVEN RD
CHAUNCEY WV
25612-9504
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1385
  • Fax: 304-369-9684
Mailing address:
  • Phone: 304-688-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number66370
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: