Gordon Coburn, APRN, BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11054 Issued in TN

Practice address

119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998

Phone

(423) 282-1480

Fax

(423) 928-1353

NPI assigned

Nov 22, 2006

Last updated

Apr 28, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Frontier Health

  dba Hancock County Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sneedville, TN
  • NPI 1053475558
  NPD (past)
• Frontier Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gray, TN
  • NPI 1720147408
  NPD (past)
• Neurobehavioral Associates

  • Clinical Neuropsychologist
  • Johnson City, TN
  • NPI 1174727309
  NPD (past)
• Wayne E. Tasker and Associates, Inc.

  • Clinical Social Worker
  • Morristown, TN
  • NPI 1295974319

  Adult Health

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430179200000",
    "number": "1396810529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-282-1480",
            "fax_number": "423-928-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-282-1480",
            "fax_number": "423-928-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "GORDON",
        "name_prefix": "Mr.",
        "credential": "APRN, BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2015-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TN",
            "license": "11054",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024166489",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "11054",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024166489",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q008267",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1504748",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tavis D. Clonch, P.A.
• David R Clopton, M.D.
• Deborah G Cloyd, LPC
• Anita Diane Cobble, MD
• Patricia G Coble
• Heather L Coburn, PA-C
• Emilee Grace Cochran
• Linda Sue Coeburn, LCSW
• Tyler Coffey, RPH
• Harriet Coggan, PT, DPT

• Psychiatric/Mental Health Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.