MEDICARE: CARMEN COLEMAN

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1801210885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN COLEMAN

Provider Business Mailing Address
First Line	:	PO BOX 19036
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1036
Country	:	US
Telephone Number	:	682-703-2449
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 PATHWAY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-2743
Country	:	US
Telephone Number	:	682-703-2449
Fax Number	:

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

Provider Enumeration Date	:	02/11/2014
Last Update Date	:	02/11/2014

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Directions to “ CARMEN COLEMAN ” Practice Location

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