Provider Demographics
NPI:1801497052
Name:COLEMAN, KIZZIE ANN
Entity type:Individual
Prefix:MS
First Name:KIZZIE
Middle Name:ANN
Last Name:COLEMAN
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 1:708 COTTONWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189
Mailing Address - Country:US
Mailing Address - Phone:972-922-2670
Mailing Address - Fax:469-717-9044
Practice Address - Street 1:708 COTTONWOOD WAY
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189
Practice Address - Country:US
Practice Address - Phone:469-610-0754
Practice Address - Fax:469-717-9044
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide