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JOHNNY KEITH COLEMAN P.A.-C.

Primary Care >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1174558845

Individual Registrant:
 JOHNNY KEITH COLEMAN P.A.-C.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
3302 RENNER DR  FORTUNA, CA 95540-7103 US
Tel: 707-725-3318  Fax: 707-725-9396

Contact information for business:
3302 RENNER DR  FORTUNA, CA 95540-3120 US
Tel: 707-725-3318  Fax: 707-725-9396

Registration Information:
NPI: 1174558845
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP2300XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Primary Care
CAPA13661

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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