Provider Demographics
NPI:1902904584
Name:COGGINS, KAY T (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:T
Last Name:COGGINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:STE 175
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6403
Mailing Address - Country:US
Mailing Address - Phone:615-864-8703
Mailing Address - Fax:615-208-1308
Practice Address - Street 1:411 GRIFFIN STREET
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773
Practice Address - Country:US
Practice Address - Phone:662-494-5863
Practice Address - Fax:662-494-5287
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR652822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117481Medicaid
S28518Medicare UPIN
MS00117481Medicaid