Provider Demographics
NPI:1609317049
Name:COLEMAN, COLLEEN (AGNP-C)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:BOWERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:MP III, SUITE 4000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-932-3300
Practice Address - Fax:816-932-5793
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017017452363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care