MEDICARE: AMY MICHELLE COENEN

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	207Q00000X	Family Medicine Physician	0024193425	VA

General Provider Information

NPI Number	:	1639068224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MICHELLE COENEN

Provider Business Mailing Address
First Line	:	36 BEVERLY HILLS DR
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-2139
Country	:	US
Telephone Number	:	757-880-2254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 EXECUTIVE DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2402
Country	:	US
Telephone Number	:	757-880-2254
Fax Number	:

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

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	01/05/2026

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