WILLETT BLAKE COFFMAN — NPI 1578262192 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers

CMS-1500 Box 24J / 33a • NPI

1578262192

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363L00000X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner

Box 32 Service Location & ZIP+4

64 PALMER DR, JACKSON, TN, 38305-8029

✓ 9-Digit EDI 837 ZIP+4 (38305-8029)

Practice Phone & Referral Fax

(731) 614-0728

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1578262192 (WILLETT BLAKE COFFMAN) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1578262192` (NPI-1 Individual Practitioner)
Provider / Legal Name	WILLETT BLAKE COFFMAN
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner NUCC Code: `363L00000X` (Nurse Practitioner)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	64 PALMER DR, JACKSON, TN, 38305-8029
Practice Telephone / Fax	Tel: (731) 614-0728
Administrative Mailing Address	64 PALMER DR, JACKSON, TN, 38305-8029
Enumeration & Last Sync	Enumerated: 2023-03-02 \| CMS Record Updated: 2026-06-10

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

64 PALMER DR, JACKSON, TN, 38305-8029

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Plain-English Taxonomy & CMS Crosswalk (363L00000X)

What Does Taxonomy Code 363L00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363L00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (WILLETT BLAKE COFFMAN)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207P00000X` — Emergency Medicine Plain English: Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)	State: VA \| License: `0024195588` \| Primary: Secondary
`208100000X` — Physical Medicine & Rehabilitation Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation	State: VA \| License: `0024195588` \| Primary: Secondary
`207R00000X` — Internal Medicine Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: VA \| License: `0024195588` \| Primary: Secondary
`208000000X` — Pediatrics Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: VA \| License: `0024195588` \| Primary: Secondary
`207Q00000X` — Family Medicine Plain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)	State: VA \| License: `0024195588` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: TN \| License: `35606` \| Primary: Secondary
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: TN \| License: `35606` \| Primary: Yes (Primary)
`208600000X` — Surgery Plain English: Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon)	State: TN \| License: `35606` \| Primary: Secondary
`207P00000X` — Emergency Medicine Plain English: Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)	State: TN \| License: `35606` \| Primary: Secondary
`208100000X` — Physical Medicine & Rehabilitation Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation	State: TN \| License: `35606` \| Primary: Secondary
`208000000X` — Pediatrics Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: TN \| License: `35606` \| Primary: Secondary
`207Q00000X` — Family Medicine Plain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)	State: TN \| License: `35606` \| Primary: Secondary
`207R00000X` — Internal Medicine Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: TN \| License: `35606` \| Primary: Secondary
`2085R0202X` — Radiology, Diagnostic Radiology Plain English: Board-Certified Diagnostic Radiologist (MRI, CT, Ultrasound & X-Ray Specialist)	State: VA \| License: `0024195588` \| Primary: Secondary
`208600000X` — Surgery Plain English: Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon)	State: VA \| License: `0024195588` \| Primary: Secondary

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WILLETT BLAKE COFFMAN (NPI #1578262192)