Provider Demographics
NPI:1851894471
Name:COLLEY, THOMAS PERRY (APRN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PERRY
Last Name:COLLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7356
Mailing Address - Country:US
Mailing Address - Phone:270-703-9697
Mailing Address - Fax:
Practice Address - Street 1:301 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7356
Practice Address - Country:US
Practice Address - Phone:270-703-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily