Healthcare Provider Details

I. General information

NPI: 1982286548
Provider Name (Legal Business Name): TAMARA COOTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LINDSEY WILSON ST
COLUMBIA KY
42728-1298
US

IV. Provider business mailing address

210 LINDSEY WILSON ST
COLUMBIA KY
42728-1298
US

V. Phone/Fax

Practice location:
  • Phone: 127-038-4813
  • Fax:
Mailing address:
  • Phone: 127-038-4813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number1136598
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: