Provider Demographics
NPI:1861830408
Name:COLEMAN, KIONA P (MC)
Entity Type:Individual
Prefix:
First Name:KIONA
Middle Name:P
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD STE 234
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-468-9999
Mailing Address - Fax:972-981-3600
Practice Address - Street 1:6124 W PARKER RD STE 234
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-468-9999
Practice Address - Fax:972-981-3600
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10046112207Q00000X
TXQ6167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-001OtherTRICARE
TX8FS771OtherBCBS
TX476950YN3XOtherMEDICARE
TX75-2616977-113OtherTRICARE
TX75-2771569-008OtherTRICARE
TXP01844883OtherRAIL ROAD MEDICARE
TX355357003Medicaid
TXP01617616OtherRAIL ROAD MEDICARE
TX355357002Medicaid
TX8FS774OtherBCBS
TX75-2616977-002OtherTRICARE
TX8GW409OtherBCBS
TX75-2616977-028OtherTRICARE
TX75-2616977-066OtherTRICARE
TXP01618252OtherRAIL ROAD MEDICARE
TX476950YNSXMedicare PIN
TX75-2616977-066OtherTRICARE