Provider Demographics
NPI:1386215598
Name:COLEMAN, KIMBERLY ANN (PHD, LAC, RN)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD, LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 FRIENDSHIP BLVD APT 1705N
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7210
Mailing Address - Country:US
Mailing Address - Phone:240-600-1279
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 850
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4446
Practice Address - Country:US
Practice Address - Phone:240-600-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1060952163W00000X
MDR248256163W00000X
DCAC500333171100000X
MDU02826171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse