Healthcare Provider Details

I. General information

NPI: 1407226681
Provider Name (Legal Business Name): JENNY JOHNSTON COLEMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COOKS HILL RD STE F
CENTRALIA WA
98531-9162
US

IV. Provider business mailing address

6928 47TH AVE NE
OLYMPIA WA
98516-2103
US

V. Phone/Fax

Practice location:
  • Phone: 360-669-0335
  • Fax: 360-736-2967
Mailing address:
  • Phone: 206-617-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60595033
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60595033
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: