Provider Demographics
NPI:1497521280
Name:COLES, MAKAYLA R
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:R
Last Name:COLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 JEFFERSON ST N STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-5796
Mailing Address - Country:US
Mailing Address - Phone:304-645-7420
Mailing Address - Fax:304-645-7112
Practice Address - Street 1:2947 JEFFERSON ST N STE 2
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-5796
Practice Address - Country:US
Practice Address - Phone:304-645-7420
Practice Address - Fax:304-645-7112
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker