Healthcare Provider Details

I. General information

NPI: 1689050593
Provider Name (Legal Business Name): HOLLIE COATES-HENSLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLIE JEAN COATES

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MOCKINGBIRD AVE
PARROTTSVILLE TN
37843-2741
US

IV. Provider business mailing address

PO BOX 577
NEWPORT TN
37822-0577
US

V. Phone/Fax

Practice location:
  • Phone: 423-625-1170
  • Fax: 423-625-3618
Mailing address:
  • Phone: 423-613-3300
  • Fax: 423-623-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN157970
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN20209
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: