Coburn, Gordon

Coburn, Gordon is an individual health care provider with primary practice located at 119 Boone Ridge Dr Suite 201, Johnson City TN 37615-4998. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Coburn, Gordon can be contacted via phone (423) 282-1480.

Contact Information

Primary practice address
119 Boone Ridge Dr Suite 201 Johnson City TN 37615-4998
Phone: (423) 282-1480
Fax: (423) 928-1353
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 11054 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 11054 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 0024166489 Virginia
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 0024166489 Virginia

Profile Details

NPI number 1396810529
LBN Legal business name Coburn, Gordon
Credentials APRN, BC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2006
Last updated Apr 28th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396810529 NPPES
Tennessee MEDICAID 1504748
Tennessee MEDICAID Q008267

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