Healthcare Provider Details

I. General information

NPI: 1558740415
Provider Name (Legal Business Name): KARA COLEMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA EBERHARDT

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 76
CLARKSVILLE TN
37043-8405
US

IV. Provider business mailing address

1000 HIGHWAY 76
CLARKSVILLE TN
37043-8405
US

V. Phone/Fax

Practice location:
  • Phone: 931-245-1150
  • Fax: 931-245-1153
Mailing address:
  • Phone: 931-245-1150
  • Fax: 931-245-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A17402
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4268
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: