Provider Demographics
NPI:1659546604
Name:COLEMAN, TERRA KAY
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:KAY
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 1:412 BULL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAURELVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43135-9405
Mailing Address - Country:US
Mailing Address - Phone:740-216-8972
Mailing Address - Fax:
Practice Address - Street 1:1920 N BRIDGE ST
Practice Address - Street 2:APT 203
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4133
Practice Address - Country:US
Practice Address - Phone:740-637-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 110063164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse