MEDICARE: CHRISTINA COLEY NP

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	9700811	NC
2	363LF0000X	Family Nurse Practitioner	09458-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9700811	OTHER	NC	STATE LICENSE NUMBER
2	COA.09458-NP	OTHER	OH	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1336242619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA COLEY NP

Provider Business Mailing Address
First Line	:	1602 W AVENUE A
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-4080
Country	:	US
Telephone Number	:	254-899-2225
Fax Number	:	254-899-2225

Provider Business Practice Location Address
First Line	:	1602 W AVENUE A
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-4080
Country	:	US
Telephone Number	:	254-899-2225
Fax Number	:	254-899-2225

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	03/07/2023

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