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General NPI Number Information
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NPI Number | 1831133016
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Entity Type | Individual
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Provider Name | KELLY M COLEMAN NP
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 933 3 MILE RD NW STE 210
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City | WALKER
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State | MI
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Zip | 49544-1673
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Country | US
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Telephone | 616-685-8150
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Fax | 616-785-0238
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Provider Business Mailing Address
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Address Line | 2332 KNAPP FOREST CT NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9750
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Country | US
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Telephone | 812-459-7649
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704243275
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License Number State | MI
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