Provider Demographics
NPI:1891258984
Name:COLEMAN, BEVERLY ANN (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 ALLEN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-4414
Mailing Address - Country:US
Mailing Address - Phone:865-406-4507
Mailing Address - Fax:
Practice Address - Street 1:2696 ALLEN SHORE DR
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-4414
Practice Address - Country:US
Practice Address - Phone:865-406-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000060575163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse