Individual
KATIE E COPELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3277 E LOUISE DR, SUITE 200, MERIDIAN, ID 83642-9351
(208) 468-5930
(208) 463-3044
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 463-3044
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M8753
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142776
BLUE SHIELD
ID
01
—
370022701
RR MEDICARE
ID
01
—
53199
BLUE CROSS
ID
05
—
806551600
—
ID
01
—
806567400
HEALTHY CONNECTIONS
ID
Enumeration date
10/21/2005
Last updated
07/26/2021
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