Healthcare Provider Details

I. General information

NPI: 1063637270
Provider Name (Legal Business Name): KELLIE DOBIAS COFFEY APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WEAKLEY CREEK RD
LAWRENCEBURG TN
38464-2238
US

IV. Provider business mailing address

413 DOUGLAS DR
LAWRENCEBURG TN
38464-2734
US

V. Phone/Fax

Practice location:
  • Phone: 931-766-5001
  • Fax: 931-762-3800
Mailing address:
  • Phone: 615-430-7038
  • Fax: 931-762-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: