Basic Information
| Provider Information | |||||||||
| NPI: | 1326296674 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOMER | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | CELESTE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3115 W WALNUT ST | ||||||||
| Address2: | CONDO #9 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376045800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657892969 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 N STATE OF FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234316671 | ||||||||
| FaxNumber: | 4234315124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 01/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 137415 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.