Provider Demographics
NPI:1619590205
Name:COLEMAN, KATELYN RHEA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:RHEA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:RHEA
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CARDINAL WAY APT 1010
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63102-2812
Mailing Address - Country:US
Mailing Address - Phone:217-741-7992
Mailing Address - Fax:
Practice Address - Street 1:1390 US HIGHWAY 61 STE N1500
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-937-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021289363LF0000X
MO2020013110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily