Provider Demographics
NPI:1326296674
Name:COOMER, AMBER CELESTE (MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:CELESTE
Last Name:COOMER
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 W WALNUT ST
Mailing Address - Street 2:CONDO #9
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5800
Mailing Address - Country:US
Mailing Address - Phone:865-789-2969
Mailing Address - Fax:
Practice Address - Street 1:325 N STATE OF FRANKLIN RD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-439-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21483363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ028838Medicaid