MEDICARE: JUELDA R COLEMAN APN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	14154	TN
2	364SF0001X	Family Health Clinical Nurse Specialist	14154	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14154	OTHER	TN	APN
2	135432	OTHER	TN	RN#

General Provider Information

NPI Number	:	1245466135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUELDA R COLEMAN APN, RN

Provider Business Mailing Address
First Line	:	9437 HIGHWAY 70 EAST
Second Line	:
City	:	MCEWEN
State	:	TN
Zip	:	37101-4859
Country	:	US
Telephone Number	:	931-582-8820
Fax Number	:	931-582-8970

Provider Business Practice Location Address
First Line	:	9437 HIGHWAY 70 EAST
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4859
Country	:	US
Telephone Number	:	931-582-8820
Fax Number	:	931-582-8970

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	06/18/2015

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