MEDICARE: MR. JASON BRIAN COPELAND FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	902488	MS

General Provider Information

NPI Number	:	1326538315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON BRIAN COPELAND FNP-C

Provider Business Mailing Address
First Line	:	4443 MARS HILL RD
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-1918
Country	:	US
Telephone Number	:	601-479-9760
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 W BEACON ST
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-3218
Country	:	US
Telephone Number	:	769-200-0730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/30/2023

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