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General NPI Number Information
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NPI Number | 1326538315
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Entity Type | Individual
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Provider Name | JASON BRIAN COPELAND FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 1017 W BEACON ST
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3218
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Country | US
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Telephone | 769-200-0730
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Fax |
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Provider Business Mailing Address
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Address Line | 4443 MARS HILL RD
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City | PHILADELPHIA
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State | MS
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Zip | 39350-1918
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Country | US
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Telephone | 601-479-9760
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 902488
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License Number State | MS
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