Provider Demographics
NPI:1679992978
Name:COGHILL, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:COGHILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ANDREA ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3382
Mailing Address - Country:US
Mailing Address - Phone:270-904-2260
Mailing Address - Fax:270-781-9680
Practice Address - Street 1:1300 ANDREA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3382
Practice Address - Country:US
Practice Address - Phone:270-904-2260
Practice Address - Fax:270-781-9680
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18580363LP0808X
KY3008574363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health