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General NPI Number Information
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NPI Number | 1649997669
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Entity Type | Organization
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Legal Business Name | COFFMAN FAMILY CARE AND WELLNESS PLLC
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 1221 N MAIN ST
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City | BEAVER DAM
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State | KY
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Zip | 42320-8955
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Country | US
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Telephone | 270-256-5911
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 THOMPSON DR
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City | BEAVER DAM
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State | KY
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Zip | 42320-9152
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Country | US
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Telephone | 270-256-5911
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA COFFMAN
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Credential |
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Telephone | 270-256-5911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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