Provider Demographics
NPI:1578135414
Name:COFFEY, PAMELA L
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:COFFEY
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 1:1835 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2082
Mailing Address - Country:US
Mailing Address - Phone:269-352-6908
Mailing Address - Fax:
Practice Address - Street 1:713 SIMPSON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-2438
Practice Address - Country:US
Practice Address - Phone:269-352-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator