Healthcare Provider Details

I. General information

NPI: 1891319000
Provider Name (Legal Business Name): KERI JO COLEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1759 BROAD PARK CIR S STE 113
MANSFIELD TX
76063-7836
US

IV. Provider business mailing address

1759 BROAD PARK CIR S STE 113
MANSFIELD TX
76063-7836
US

V. Phone/Fax

Practice location:
  • Phone: 817-473-1312
  • Fax: 866-990-2813
Mailing address:
  • Phone: 817-473-1312
  • Fax: 866-990-2813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN768309
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: