Provider Demographics
NPI:1902499023
Name:COTHRAN, HALLIE BAIN (PA-C)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:BAIN
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:LOGAN
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3443 DICKERSON PIKE STE 520
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2520
Mailing Address - Country:US
Mailing Address - Phone:615-860-5540
Mailing Address - Fax:615-860-5539
Practice Address - Street 1:3441 DICKERSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2539
Practice Address - Country:US
Practice Address - Phone:615-860-5540
Practice Address - Fax:615-860-5539
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4560363A00000X
GA10349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant