Healthcare Provider Details

I. General information

NPI: 1609132521
Provider Name (Legal Business Name): FELICIA KAYE COLEMAN ANP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N FREDONIA ST
LONGVIEW TX
75601-6464
US

IV. Provider business mailing address

1107 E MARSHALL AVE
LONGVIEW TX
75601-5602
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-2610
  • Fax: 903-758-7081
Mailing address:
  • Phone: 903-758-2610
  • Fax: 903-758-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP121675
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number653053
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP121675
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: