Provider Demographics
NPI:1538040837
Name:COPELAND, JEFFREY RICHARD (PSGT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RICHARD
Last Name:COPELAND
Suffix:
Gender:M
Credentials:PSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 GRAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2642
Mailing Address - Country:US
Mailing Address - Phone:612-999-5244
Mailing Address - Fax:
Practice Address - Street 1:598 GRAND AVE APT 2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2642
Practice Address - Country:US
Practice Address - Phone:612-999-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health