Basic Information
| Provider Information | |||||||||
| NPI: | 1518095033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPELAND | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM-MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043165270 | ||||||||
| FaxNumber: | 7043165271 | ||||||||
| Practice Location | |||||||||
| Address1: | 1718 EAST 4TH STREET | ||||||||
| Address2: | SUITE 707 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043165270 | ||||||||
| FaxNumber: | 7043165271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 318 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 2592534B | 01 | NC | CIGNA MEDICARE | OTHER | 7002061 | 05 | NC | MEDICAID |