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General NPI Number Information
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NPI Number | 1447240437
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Entity Type | Individual
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Provider Name | KATIE E COPELAND M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 3277 E LOUISE DR SUITE 200
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City | MERIDIAN
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State | ID
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Zip | 83642-9351
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Country | US
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Telephone | 208-468-5930
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Fax | 208-463-3044
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-2222
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Fax | 208-463-3044
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M8753
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License Number State | ID
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