Healthcare Provider Details

I. General information

NPI: 1174980437
Provider Name (Legal Business Name): KELLY COLEMAN MSN, APRN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 S 1ST ST
AUSTIN TX
78704-7048
US

IV. Provider business mailing address

6210 E HWY 290
AUSTIN TX
78723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-1311
  • Fax: 512-406-6266
Mailing address:
  • Phone: 512-483-9596
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAP129019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: