Provider Demographics
NPI:1689050593
Name:COATES-HENSLEY, HOLLIE (FNP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:COATES-HENSLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:JEAN
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37822-0577
Mailing Address - Country:US
Mailing Address - Phone:423-613-3300
Mailing Address - Fax:423-623-4088
Practice Address - Street 1:111 MOCKINGBIRD AVE
Practice Address - Street 2:
Practice Address - City:PARROTTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37843-2741
Practice Address - Country:US
Practice Address - Phone:423-625-1170
Practice Address - Fax:423-625-3618
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN157970163W00000X
TNAPN20209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015379Medicaid
TNQ015379Medicaid