Basic Information
Provider Information
NPI: 1003003443
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COPAS
FirstName: VIRGINIA
MiddleName: DIANE
NamePrefix: MRS.
NameSuffix:  
Credential: RN.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2312 COLONIAL VIEW ROAD
Address2:  
City: KINGSPORT
State: TN
PostalCode: 37663
CountryCode: US
TelephoneNumber: 4232393614
FaxNumber:  
Practice Location
Address1: 904 FORDTOWN RD
Address2:  
City: KINGSPORT
State: TN
PostalCode: 376633208
CountryCode: US
TelephoneNumber: 4233541760
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/01/2007
LastUpdateDate: 10/01/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WS0200XRN0000085014TNY Nursing Service ProvidersRegistered NurseSchool

No ID Information.


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