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General NPI Number Information
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NPI Number | 1891418281
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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 | 09/21/2022
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Last Update Date | 09/21/2022
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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 | 270-339-7791
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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 | 270-339-7791
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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 | NURSE PRACTITIONER
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Telephone | 270-339-7791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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