Provider Demographics
NPI:1407189756
Name:COLEMAN, KELLY K (PSYD, ABPP, RD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:K
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PSYD, ABPP, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2133
Mailing Address - Country:US
Mailing Address - Phone:808-286-2659
Mailing Address - Fax:
Practice Address - Street 1:2113 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2133
Practice Address - Country:US
Practice Address - Phone:808-286-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60056916133V00000X
HIPSY-1225103TC0700X
WAPY 60130390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH00433047OtherDRIVERS LICENSE