Healthcare Provider Details

I. General information

NPI: 1588010110
Provider Name (Legal Business Name): LEAH KOTHLOW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 HILLSBORO PIKE
NASHVILLE TN
37215-2117
US

IV. Provider business mailing address

3715 HILLSBORO PIKE
NASHVILLE TN
37215-2117
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-0622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000019192
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: