Individual
HEATHER L COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1019 W OAKLAND AVE, SUITE 1, JOHNSON CITY, TN 37604
(423) 915-5000
(423) 915-5045
Mailing address
1019 W OAKLAND AVE, SUITE 1, JOHNSON CITY, TN 37604-2357
(423) 915-5000
(423) 915-5045
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01205
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932165545
—
VA
05
—
Q003283
—
TN
Enumeration date
04/22/2006
Last updated
06/04/2018
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