Provider Demographics
NPI:1235629205
Name:COOMES, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:COOMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 PRENDA DE ORO NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1337
Mailing Address - Country:US
Mailing Address - Phone:815-677-5152
Mailing Address - Fax:
Practice Address - Street 1:5900 PRENDA DE ORO NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1337
Practice Address - Country:US
Practice Address - Phone:815-677-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist