Provider Demographics
NPI:1235553926
Name:COFFMAN, LEAH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N FINDLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6412
Mailing Address - Country:US
Mailing Address - Phone:405-364-0643
Mailing Address - Fax:
Practice Address - Street 1:809 N FINDLAY AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6412
Practice Address - Country:US
Practice Address - Phone:405-364-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200539160AMedicaid