Healthcare Provider Details

I. General information

NPI: 1992740682
Provider Name (Legal Business Name): HEATHER COATES P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 HIGHWAY 46 S
DICKSON TN
37055-2502
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 209
DICKSON TN
37055-2856
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-2708
  • Fax: 615-441-5121
Mailing address:
  • Phone: 615-446-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1298
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: