Provider Demographics
NPI:1821230707
Name:COLEMAN, REBECCA J (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:SHORTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1065 HIGHWAY 248
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8398
Mailing Address - Country:US
Mailing Address - Phone:417-336-6011
Mailing Address - Fax:417-336-9827
Practice Address - Street 1:1065 HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8398
Practice Address - Country:US
Practice Address - Phone:417-336-6011
Practice Address - Fax:417-336-9827
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000159434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176434758Medicaid
431560263OtherTRICARE WEST
P00700788OtherRAILROAD MEDICARE
MO1821230707Medicaid
MO132300043Medicare PIN