Basic Information
| Provider Information | |||||||||
| NPI: | 1184237463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFFEY | ||||||||
| FirstName: | CORY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2673 E 100 N | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460129684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656172289 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 W UNIVERSITY AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473033432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652812000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2020 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 28236674A | IN | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 363LF0000X | 71011414A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.