Provider Demographics
NPI:1427115260
Name:COULY, LOUIS D (PA)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:D
Last Name:COULY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:LOUIS
Other - Middle Name:D
Other - Last Name:COULY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2320 WILMA RUDOLPH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8960
Mailing Address - Country:US
Mailing Address - Phone:931-645-1564
Mailing Address - Fax:931-645-3842
Practice Address - Street 1:2320 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8960
Practice Address - Country:US
Practice Address - Phone:931-645-1564
Practice Address - Fax:931-645-3842
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1052220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNVA000Medicare UPIN