Provider Demographics
NPI:1063493815
Name:COHEN, KATHY (MSN,CFNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:MSN,CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4519
Mailing Address - Country:US
Mailing Address - Phone:931-363-2925
Mailing Address - Fax:931-363-9563
Practice Address - Street 1:1150 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4519
Practice Address - Country:US
Practice Address - Phone:931-363-2925
Practice Address - Fax:931-363-9563
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000092705363L00000X
TNAPN0000006710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907648Medicaid
TN4069708Medicaid
TNP03678Medicare UPIN