Provider Demographics
NPI:1194019570
Name:KOHLI, SUPRIYA (MD)
Entity Type:Individual
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First Name:SUPRIYA
Middle Name:
Last Name:KOHLI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:230 LEXINGTON GREEN CIR
Mailing Address - Street 2:STE 600
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4294
Practice Address - Country:US
Practice Address - Phone:931-783-2770
Practice Address - Fax:931-525-1176
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2020-12-07
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Provider Licenses
StateLicense IDTaxonomies
TN524892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7100421860Medicaid
TNQ020404Medicaid
TN6060965OtherBCBS