1972655462 NPI number — MRS. ELIZABETH HUGHES COPELAND CFNP

Table of content: MRS. ELIZABETH HUGHES COPELAND CFNP (NPI 1972655462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972655462 NPI number — MRS. ELIZABETH HUGHES COPELAND CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPELAND
Provider First Name:
ELIZABETH
Provider Middle Name:
HUGHES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COPELAND
Provider Other First Name:
BETSY
Provider Other Middle Name:
HUGHES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CFNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972655462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 DESIARD ST
Provider Second Line Business Mailing Address:
SUITE 355
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-7319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-807-7875
Provider Business Mailing Address Fax Number:
318-812-6603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 OLIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-5702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-807-6267
Provider Business Practice Location Address Fax Number:
318-812-6458
Provider Enumeration Date:
01/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP06409 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00125082 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2166387 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".