=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366605446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA MARIE COFFMAN PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2008
-----------------------------------------------------
Last Update Date | 04/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 W 3RD ST SUITE C
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73644-4337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-2513
-----------------------------------------------------
Fax | 580-303-5863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2339
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73648-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-2513
-----------------------------------------------------
Fax | 580-303-5863
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 346
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------