Provider Demographics
NPI:1841237294
Name:COLEMAN, KAREN ALYCE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ALYCE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ALYCE
Other - Last Name:KIEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2946 E. BANNER GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-256-6444
Mailing Address - Fax:480-256-3682
Practice Address - Street 1:2946 E. BANNER GATEWAY DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:602-406-4000
Practice Address - Fax:602-406-6498
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3133363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830004OtherMEDICARE NSC PV
AZ5550830007OtherMEDICARE NSC DV
AZP00214608OtherRR MEDICARE
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ906480Medicaid
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830010OtherMEDICARE NSC GILBERT
AZ5550830006OtherMEDICARE NSC ANTHEM
AZZ102180Medicare PIN