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General NPI Number Information
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NPI Number | 1043855372
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Entity Type | Individual
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Provider Name | MELISSA COLEMAN
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Gender | Female
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 540 ILLINOIS ST
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City | PAWNEE
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State | OK
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Zip | 74058-2036
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Country | US
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Telephone | 918-762-1045
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Fax |
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Provider Business Mailing Address
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Address Line | 346301 E 4100 RD
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City | PAWNEE
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State | OK
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Zip | 74058-2440
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Country | US
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Telephone | 918-729-5199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 314179
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License Number State | OK
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