Provider Demographics
NPI:1386968444
Name:NORTH CHILDREN'S CLINIC AND FAMILY CARE, PLLC
Entity type:Organization
Organization Name:NORTH CHILDREN'S CLINIC AND FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:615-826-8087
Mailing Address - Street 1:130 IMPERIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3440
Mailing Address - Country:US
Mailing Address - Phone:615-826-8087
Mailing Address - Fax:615-826-8069
Practice Address - Street 1:130 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3440
Practice Address - Country:US
Practice Address - Phone:615-826-8087
Practice Address - Fax:615-826-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1540363AM0700X
TNAPN8129363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441217Medicaid