Provider Demographics
NPI:1639807506
Name:COLEMAN, KIERRA ELAINE
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:ELAINE
Last Name:COLEMAN
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 1:84156 OLONA CT
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2968
Mailing Address - Country:US
Mailing Address - Phone:760-880-9060
Mailing Address - Fax:
Practice Address - Street 1:84156 OLONA CT
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-2968
Practice Address - Country:US
Practice Address - Phone:760-880-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty