Provider Demographics
NPI:1750659462
Name:COATES, JENNIFER M (MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:COATES
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, ARNP
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-0645
Mailing Address - Country:US
Mailing Address - Phone:253-268-9299
Mailing Address - Fax:253-799-9057
Practice Address - Street 1:1818 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1953
Practice Address - Country:US
Practice Address - Phone:253-268-9299
Practice Address - Fax:253-799-9057
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007912363LP0808X
WAAP60262506363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100250620Medicaid
KYK091660Medicare PIN