Provider Demographics
NPI:1245995471
Name:COACHMAN, KEARA NASHI
Entity type:Individual
Prefix:MS
First Name:KEARA
Middle Name:NASHI
Last Name:COACHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 13TH CT NW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5967
Mailing Address - Country:US
Mailing Address - Phone:205-427-1631
Mailing Address - Fax:
Practice Address - Street 1:705 13TH CT NW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5967
Practice Address - Country:US
Practice Address - Phone:205-427-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL
AL8282725347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALOOtherO