Provider Demographics
NPI:1669654570
Name:COLEMAN, MARSHALL CHAD (APN)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:CHAD
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52230
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-2230
Mailing Address - Country:US
Mailing Address - Phone:806-350-2663
Mailing Address - Fax:806-350-2665
Practice Address - Street 1:7000 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1709
Practice Address - Country:US
Practice Address - Phone:806-350-2663
Practice Address - Fax:806-350-2665
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327603203Medicaid
TXP00006668OtherPROMINENCE HEALTH
TX8369NJOtherBCBS
TXP01359598OtherRAILROAD MEDICARE
TX327603203Medicaid