Healthcare Provider Details

I. General information

NPI: 1649997669
Provider Name (Legal Business Name): COFFMAN FAMILY CARE AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 TOWN SQUARE DR
BEAVER DAM KY
42320-9135
US

IV. Provider business mailing address

1221 N MAIN ST
BEAVER DAM KY
42320-8955
US

V. Phone/Fax

Practice location:
  • Phone: 270-775-6060
  • Fax: 270-775-6010
Mailing address:
  • Phone: 270-775-6060
  • Fax: 270-775-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA COFFMAN
Title or Position: LEAD APRN
Credential: APRN-FNP-C, PMHNP
Phone: 270-775-6060