MR. GORDON COBURN APRN BC NPI 1396810529

NPI Information

  • NPI: 1396810529
  • Provider Name: MR. GORDON COBURN, APRN, BC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 119 BOONE RIDGE DR
    SUITE 201
    JOHNSON CITY, TN
    ZIP 37615
  • Phone: (423) 282-1480

Map and Directions

Get Directions

NPI Details

MR. Gordon Coburn, APRN, BC is a psychiatric/mental health nurse practitioner in Johnson City, TN. MR. Gordon Coburn, APRN, BC NPI is 1396810529. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

119 BOONE RIDGE DR
SUITE 201
JOHNSON CITY, TN
ZIP 37615-998
Phone: (423) 282-1480
Fax: (423) 928-1353

The NPI 1396810529 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/22/2006 and was last updated on 4/28/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2200XNurse PractitionerAdult Health11054TENNESSEENo
2363LA2200XNurse PractitionerAdult Health0024166489VIRGINIANo
3363LP0808XNurse PractitionerPsychiatric/Mental Health0024166489VIRGINIANo
4363LP0808XNurse PractitionerPsychiatric/Mental Health11054TENNESSEEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
110350I3965MEDICARE PINTENNESSEE
2Q44474MEDICARE UPIN
3VV9628BMEDICARE PINVIRGINIA
4Q008267MEDICAIDTENNESSEE
51504748MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI