Provider Demographics
NPI:1083612311
Name:COAN, JUSTIN KEITH (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:KEITH
Last Name:COAN
Suffix:
Gender:M
Credentials:CRNP
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Other - First Name:
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Mailing Address - Street 1:1100 S JACKSON HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5774
Mailing Address - Country:US
Mailing Address - Phone:256-386-4680
Mailing Address - Fax:256-386-4682
Practice Address - Street 1:1100 S JACKSON HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5774
Practice Address - Country:US
Practice Address - Phone:256-386-4680
Practice Address - Fax:256-386-4682
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1079792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS91187Medicare UPIN