MEDICARE: KANNESHA 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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1871254128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANNESHA COLEMAN

Provider Business Mailing Address
First Line	:	4371 CHARLOTTE HWY STE 22
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8105
Country	:	US
Telephone Number	:	803-589-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4371 CHARLOTTE HWY STE 22
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8105
Country	:	US
Telephone Number	:	803-589-7999
Fax Number	:

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

Provider Enumeration Date	:	01/07/2022
Last Update Date	:	07/04/2022

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Directions to “ KANNESHA COLEMAN ” Practice Location

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