Healthcare Provider Details

I. General information

NPI: 1932712452
Provider Name (Legal Business Name): DONNA LUTHER COLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 11/27/2023
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 TYSON AVE
PARIS TN
38242-4544
US

IV. Provider business mailing address

2225 GATE 3 RD
PARIS TN
38242-8580
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-1220
  • Fax:
Mailing address:
  • Phone: 731-336-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: