Healthcare Provider Details

I. General information

NPI: 1467685933
Provider Name (Legal Business Name): BARBARA L COUGHLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 MILTON AVE
DALLAS TX
75205-1338
US

IV. Provider business mailing address

PO BOX 678696
DALLAS TX
75267-8696
US

V. Phone/Fax

Practice location:
  • Phone: 214-445-1911
  • Fax: 214-445-1912
Mailing address:
  • Phone: 972-758-3598
  • Fax: 972-599-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number600711
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: