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General NPI Number Information
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NPI Number | 1255732335
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Entity Type | Individual
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Provider Name | JEANNETTE AMAYA COPELAND PA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 77 NEALY AVE
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City | HAMPTON
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone | 757-225-6703
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Fax |
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Provider Business Mailing Address
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Address Line | 7219 N LITCHFIELD RD
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City | LUKE AIR FORCE BASE
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State | AZ
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Zip | 85309-1529
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Country | US
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Telephone | 623-856-9801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110010276
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License Number State | VA
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