MEDICARE: KAYLEE MICHELLE COFFMAN PA-C

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	363A00000X	Physician Assistant	PA14679	TX

General Provider Information

NPI Number	:	1518537588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE MICHELLE COFFMAN PA-C

Provider Business Mailing Address
First Line	:	10260 N CENTRAL EXPY # 100N
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3437
Country	:	US
Telephone Number	:	214-363-5535
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 LIPSCOMB ST STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3130
Country	:	US
Telephone Number	:	972-544-6600
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	04/03/2023

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