Provider Demographics
NPI:1548396922
Name:COKER, DIANE CHARLENE (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CHARLENE
Last Name:COKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LAMBDIN RD
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-5214
Mailing Address - Country:US
Mailing Address - Phone:865-992-1014
Mailing Address - Fax:
Practice Address - Street 1:4335 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3623
Practice Address - Country:US
Practice Address - Phone:865-992-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000102685163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse