Basic Information
| Provider Information | |||||||||
| NPI: | 1164199097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | TRENT | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040A HIGHWAY 61 S | ||||||||
| Address2: | |||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391208615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012482110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 54 SERGEANT PRENTISS DR | ||||||||
| Address2: | |||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391204726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014432680 | ||||||||
| FaxNumber: | 6014432885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2021 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 904798 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.