1003183740 NPI number — MRS. YVONNE JEANETTE COULTER PT

Table of content: MRS. YVONNE JEANETTE COULTER PT (NPI 1003183740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003183740 NPI number — MRS. YVONNE JEANETTE COULTER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COULTER
Provider First Name:
YVONNE
Provider Middle Name:
JEANETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELISE
Provider Other First Name:
YVONNE
Provider Other Middle Name:
JEANETTE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003183740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6711 MOUNTAIN VIEW RD
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
OOLTEWAH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37363-6668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-238-1127
Provider Business Mailing Address Fax Number:
423-238-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5035 HIXSON PIKE
Provider Second Line Business Practice Location Address:
SUITE 129
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-3941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-521-4997
Provider Business Practice Location Address Fax Number:
423-521-4999
Provider Enumeration Date:
11/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2115 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12311815 . This is a "CAQH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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