1518095033 NPI number — MS. CARRIE A. COPELAND CNM-MSN

Table of content: MS. CARRIE A. COPELAND CNM-MSN (NPI 1518095033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518095033 NPI number — MS. CARRIE A. COPELAND CNM-MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPELAND
Provider First Name:
CARRIE
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM-MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518095033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-316-5270
Provider Business Mailing Address Fax Number:
704-316-5271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 EAST 4TH STREET
Provider Second Line Business Practice Location Address:
SUITE 707
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-3282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-316-5270
Provider Business Practice Location Address Fax Number:
704-316-5271
Provider Enumeration Date:
02/28/2007

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: 367A00000X , with the licence number:  APRN11021494 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 318 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7002061 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2592534B . This is a "CIGNA MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 121650800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com