=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346182425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TELE NURSE PRACTITIONER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2026
-----------------------------------------------------
Last Update Date | 04/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5503 E US HIGHWAY 62
-----------------------------------------------------
City | BEAVER DAM
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42320-8945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-532-3170
-----------------------------------------------------
Fax | 835-777-1962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N HOWARD ST STE R
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201-0508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-532-3170
-----------------------------------------------------
Fax | 835-777-1962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | TINA GAY COONEY
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 270-363-4458
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------