Healthcare Provider Details

I. General information

NPI: 1346182425
Provider Name (Legal Business Name): TELE NURSE PRACTITIONER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5503 E US HIGHWAY 62
BEAVER DAM KY
42320-8945
US

IV. Provider business mailing address

100 N HOWARD ST STE R
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 270-532-3170
  • Fax: 835-777-1962
Mailing address:
  • Phone: 270-532-3170
  • Fax: 835-777-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA GAY COONEY
Title or Position: OWNER/CEO
Credential: APRN
Phone: 270-363-4458