Provider Demographics
NPI:1003153628
Name:COLEMAN, RICHARD (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LONNIE
Other - Middle Name:RICHARD
Other - Last Name:COLEMAN
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1209 S 10TH ST STE A757
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5059
Mailing Address - Country:US
Mailing Address - Phone:956-878-5409
Mailing Address - Fax:
Practice Address - Street 1:4302 S SUGAR RD STE 106
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9140
Practice Address - Country:US
Practice Address - Phone:956-381-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122831363LP0808X
TX685397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332242204Medicaid
TX334890KYPMedicare PIN