Provider Demographics
NPI:1477764769
Name:COOLEY, KIRA (MD)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 KATE BOND RD
Mailing Address - Street 2:STE 413
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4030
Mailing Address - Country:US
Mailing Address - Phone:901-937-0038
Mailing Address - Fax:901-379-0091
Practice Address - Street 1:2996 KATE BOND RD
Practice Address - Street 2:STE 413
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4030
Practice Address - Country:US
Practice Address - Phone:901-937-0038
Practice Address - Fax:901-379-0091
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57011514207V00000X
TN47051207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524089Medicaid
TN1524089Medicaid