Provider Demographics
NPI:1225203417
Name:COLEMAN, KIMBERLEY W
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:W
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 A ST
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-2324
Mailing Address - Country:US
Mailing Address - Phone:205-994-0322
Mailing Address - Fax:
Practice Address - Street 1:694 A ST
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-2324
Practice Address - Country:US
Practice Address - Phone:205-994-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRN2797982163W00000X
FLRN2555802163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight
No163W00000XNursing Service ProvidersRegistered Nurse