Provider Demographics
NPI:1518537588
Name:COFFMAN, KAYLEE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MICHELLE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 N CENTRAL EXPY # 100N
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3437
Mailing Address - Country:US
Mailing Address - Phone:214-363-5535
Mailing Address - Fax:
Practice Address - Street 1:1023 LIPSCOMB ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3130
Practice Address - Country:US
Practice Address - Phone:972-544-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant