Individual
ELLIE DIANE KOEHLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
812 N CHARLOTTE ST, DICKSON, TN 37055-1009
(660) 651-4387
Mailing address
PO BOX 5777, MARYVILLE, TN 37802-5777
(865) 246-2104
(865) 246-2106
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
281590
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
39701
TN
Other
Enumeration date
01/10/2025
Last updated
11/04/2025
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