Provider Demographics
NPI:1659865665
Name:COLEMAN, KELLIE (DC, MSN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DC, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHAWS CV
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 SHAWS CV
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4969
Practice Address - Country:US
Practice Address - Phone:866-808-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2118111N00000X
CT9164363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily