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General NPI Number Information
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NPI Number | 1386968444
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Entity Type | Organization
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Legal Business Name | NORTH CHILDREN'S CLINIC AND FAMILY CARE, PLLC
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 130 IMPERIAL BLVD
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3440
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Country | US
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Telephone | 615-826-8087
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Fax | 615-826-8069
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Provider Business Mailing Address
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Address Line | 130 IMPERIAL BLVD
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3440
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Country | US
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Telephone | 615-826-8087
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Fax | 615-826-8069
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LEEANNA F COPELAND
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Credential | CPNP
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Telephone | 615-826-8087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1540
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APN8129
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License Number State | TN
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