MEDICARE: NORTH CHILDREN'S CLINIC AND FAMILY CARE, PLLC

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	363AM0700X	Medical Physician Assistant	PA1540	TN
2	363LP0200X	Pediatric Nurse Practitioner	APN8129	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386968444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CHILDREN'S CLINIC AND FAMILY CARE, PLLC

Provider Business Mailing Address
First Line	:	130 IMPERIAL BLVD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3440
Country	:	US
Telephone Number	:	615-826-8087
Fax Number	:	615-826-8069

Provider Business Practice Location Address
First Line	:	130 IMPERIAL BLVD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3440
Country	:	US
Telephone Number	:	615-826-8087
Fax Number	:	615-826-8069

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	LEEANNA F COPELAND
Credential	:	CPNP
Telephone Number	:	615-826-8087

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	03/18/2010

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