Healthcare Provider Details

I. General information

NPI: 1083125017
Provider Name (Legal Business Name): ELIZABETH THERESE COFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH THERESE KREAGER PA-C

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY STE 7B
HENDERSON NV
89074-5889
US

IV. Provider business mailing address

1701 N GREEN VALLEY PKWY STE 7B
HENDERSON NV
89074-5889
US

V. Phone/Fax

Practice location:
  • Phone: 702-508-9119
  • Fax:
Mailing address:
  • Phone: 702-508-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2844
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010553
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802089761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: