Healthcare Provider Details

I. General information

NPI: 1205149366
Provider Name (Legal Business Name): CATHY M COLEMAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD STE 620S
CHESTERFIELD MO
63017-3619
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 636-685-7788
  • Fax: 314-205-6377
Mailing address:
  • Phone: 314-653-5643
  • Fax: 314-653-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2010003775
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: