Basic Information
| Provider Information | |||||||||
| NPI: | 1538604657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FARRIS | ||||||||
| OtherFirstName: | COURTNEY | ||||||||
| OtherMiddleName: | LAYNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1029 MEDICAL CENTER CIR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420661189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702514545 | ||||||||
| FaxNumber: | 2702514546 | ||||||||
| Practice Location | |||||||||
| Address1: | 1029 MEDICAL CENTER CIR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702514545 | ||||||||
| FaxNumber: | 2702514546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2016 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3010985 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.