MEDICARE: KATHERINE T COATE 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	NP276A	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NPJA7	OTHER	ID	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000010135254	OTHER	ID	BLUE SHIELD

General Provider Information

NPI Number	:	1619939451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE T COATE NP

Provider Business Mailing Address
First Line	:	3340 E GOLDSTONE WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1026
Country	:	US
Telephone Number	:	208-367-4700
Fax Number	:	208-367-4705

Provider Business Practice Location Address
First Line	:	600 E STATE ST
Second Line	:	STE 200
City	:	EAGLE
State	:	ID
Zip	:	83616-6081
Country	:	US
Telephone Number	:	208-367-4700
Fax Number	:	208-367-4705

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	10/03/2013

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