Basic Information
| Provider Information | |||||||||
| NPI: | 1699869404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | JAMI | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 N MONTE VISTA ST | ||||||||
| Address2: | WOMEN'S HEALTH CENTER | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748207711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803328855 | ||||||||
| FaxNumber: | 5803327374 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 N MONTE VISTA ST | ||||||||
| Address2: | WOMEN'S HEALTH CENTER | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748207711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803328855 | ||||||||
| FaxNumber: | 5803327374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363A00000X | 1072 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 100126550A | 05 | OK | MEDICAID |