Provider Demographics
NPI:1982043501
Name:COLTRAIN, MORRIS (NP)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:
Last Name:COLTRAIN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 W 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1810
Mailing Address - Country:US
Mailing Address - Phone:913-381-6900
Mailing Address - Fax:913-381-0404
Practice Address - Street 1:7010 W 107TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1810
Practice Address - Country:US
Practice Address - Phone:913-381-6900
Practice Address - Fax:913-381-0404
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-44094-042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner