Provider Demographics
NPI:1689188021
Name:COLEY, BOBBI R (PA)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:R
Last Name:COLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-0237
Mailing Address - Country:US
Mailing Address - Phone:865-935-0136
Mailing Address - Fax:877-784-1431
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3648
Practice Address - Country:US
Practice Address - Phone:865-935-0136
Practice Address - Fax:877-784-1431
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN3426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant