Provider Demographics
NPI:1063637270
Name:COFFEY, KELLIE DOBIAS (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:DOBIAS
Last Name:COFFEY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2734
Mailing Address - Country:US
Mailing Address - Phone:615-430-7038
Mailing Address - Fax:931-762-3800
Practice Address - Street 1:110 WEAKLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2238
Practice Address - Country:US
Practice Address - Phone:931-766-5001
Practice Address - Fax:931-762-3800
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily