Healthcare Provider Details

I. General information

NPI: 1336967553
Provider Name (Legal Business Name): PAULETTE L COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412B FAWN TRL
LONGVIEW TX
75604-1911
US

IV. Provider business mailing address

412B FAWN TRL
LONGVIEW TX
75604-1911
US

V. Phone/Fax

Practice location:
  • Phone: 430-215-6435
  • Fax:
Mailing address:
  • Phone: 430-215-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: