Healthcare Provider Details

I. General information

NPI: 1922634047
Provider Name (Legal Business Name): CHELSIE COFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 KLAWOCK HOLLIS HWY A
KLAWOCK AK
99925
US

IV. Provider business mailing address

PO BOX 69
KLAWOCK AK
99925-0069
US

V. Phone/Fax

Practice location:
  • Phone: 907-755-4800
  • Fax:
Mailing address:
  • Phone: 907-755-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: