Basic Information
| Provider Information | |||||||||
| NPI: | 1992715940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | LAURALEE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 STONECREST ROAD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026335565 | ||||||||
| FaxNumber: | 5026335154 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 STONECREST ROAD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026335565 | ||||||||
| FaxNumber: | 5026335154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 01/07/2010 | ||||||||
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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 | 363AM0700X | PA204 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.