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JOHNNY KEITH COLEMAN P.A.-C.
Primary Care >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1174558845
Individual Registrant: JOHNNY KEITH COLEMAN P.A.-C.
Gender: M
Not Sole Proprietor
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
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
Tel: 707-725-3318 Fax: 707-725-9396
Registration Information:
NPI: 1174558845
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Primary Care | CA | PA13661 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
