Provider Information for 1639547037
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ANAKA "TESS" COTHRON
Sex: Female
NPI: 1639547037
Last Updated: 2015-09-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1639547037 | ||||||||
| Enumeration Date | 2015-09-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 380 SUWANNEE TRAIL ST BOWLING GREEN, KY 42103-7956 United States Phone: 270-901-5000 | Fax:270-842-5268 | ||||||||
| Primary Practice Address | 800 N MAIN ST TOMPKINSVILLE, KY 42167-1037 United States Phone: 270-901-5000 | Fax:270-487-5948 | ||||||||
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