Basic Information
| Provider Information | |||||||||
| NPI: | 1861830408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | KIONA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5321 S FM 14 | ||||||||
| Address2: | |||||||||
| City: | HAWKINS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757654839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037692990 | ||||||||
| FaxNumber: | 9037695125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 07/10/2017 | ||||||||
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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 | 207Q00000X | Q6167 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | BP10046112 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 355357002 | 05 | TX | MEDICAID | 355357003 | 05 | TX | MEDICAID | P01618252 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 8FS774 | 01 | TX | BCBS | OTHER | 8GW409 | 01 | TX | BCBS | OTHER | P01617616 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 75-2616977-001 | 01 | TX | TRICARE | OTHER | 75-2616977-066 | 01 | TX | TRICARE | OTHER | 75-2616977-113 | 01 | TX | TRICARE | OTHER | P01844883 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 476950YN3X | 01 | TX | MEDICARE | OTHER | 75-2616977-002 | 01 | TX | TRICARE | OTHER | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 75-2771569-008 | 01 | TX | TRICARE | OTHER | 8FS771 | 01 | TX | BCBS | OTHER |