Provider Demographics
NPI:1245466135
Name:COLEMAN, JUELDA R (APN, RN)
Entity type:Individual
Prefix:
First Name:JUELDA
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9437 HIGHWAY 70 EAST
Mailing Address - Street 2:
Mailing Address - City:MCEWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-4859
Mailing Address - Country:US
Mailing Address - Phone:931-582-8820
Mailing Address - Fax:931-582-8970
Practice Address - Street 1:9437 HIGHWAY 70 EAST
Practice Address - Street 2:
Practice Address - City:MC EWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4859
Practice Address - Country:US
Practice Address - Phone:931-582-8820
Practice Address - Fax:931-582-8970
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14154363L00000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14154OtherAPN
TN135432OtherRN#