Provider Demographics
NPI:1558592519
Name:COLTHARP, WILL E JR (MSN, APN)
Entity Type:Individual
Prefix:MR
First Name:WILL
Middle Name:E
Last Name:COLTHARP
Suffix:JR
Gender:M
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 UPLAND DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4090
Mailing Address - Country:US
Mailing Address - Phone:615-794-1814
Mailing Address - Fax:615-794-1840
Practice Address - Street 1:2067 UPLAND DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4090
Practice Address - Country:US
Practice Address - Phone:615-794-1814
Practice Address - Fax:615-794-1840
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000098710364SP0809X
TNAPN0000014735363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341920Medicaid
TN3341920Medicaid