Provider Demographics
NPI:1720650401
Name:COLEMAN, RAQUEL LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LEIGH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1592
Mailing Address - Country:US
Mailing Address - Phone:859-623-1633
Mailing Address - Fax:
Practice Address - Street 1:239 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1592
Practice Address - Country:US
Practice Address - Phone:859-623-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily