Provider Demographics
NPI:1265024517
Name:COLEMAN, STANCY TOMEKIO (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:STANCY
Middle Name:TOMEKIO
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CRESWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2202
Mailing Address - Country:US
Mailing Address - Phone:318-540-7330
Mailing Address - Fax:318-795-8186
Practice Address - Street 1:2000 CRESWELL AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2202
Practice Address - Country:US
Practice Address - Phone:318-540-7330
Practice Address - Fax:318-795-8186
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218487363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty