Healthcare Provider Details

I. General information

NPI: 1811503410
Provider Name (Legal Business Name): ANGELA COFFMAN APRN-FNP-C, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N MAIN ST
BEAVER DAM KY
42320-8955
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015137
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3015137
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: