Provider Demographics
NPI:1366486276
Name:COFFMAN, AUDREY JOANN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:JOANN
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:JOANN
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:CARL R DARNALL ARMY MEDICAL CENTER
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-288-2621
Mailing Address - Fax:254-285-6193
Practice Address - Street 1:58TH & 761ST ST TANK BATTALION AVE
Practice Address - Street 2:THOMAS MOORE HEALTH CLINIC BLDG 2245
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-2621
Practice Address - Fax:254-285-6193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181283164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse