Provider Demographics
NPI:1801372990
Name:COLEMAN, KENYA PRETORIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:PRETORIA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6167 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3120
Mailing Address - Country:US
Mailing Address - Phone:216-253-3658
Mailing Address - Fax:
Practice Address - Street 1:6167 SUNSET DR
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3120
Practice Address - Country:US
Practice Address - Phone:216-253-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH433908163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health