Provider Demographics
NPI:1811503410
Name:COFFMAN, ANGELA (APRN-FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-8955
Mailing Address - Country:US
Mailing Address - Phone:270-775-6060
Mailing Address - Fax:270-339-7791
Practice Address - Street 1:1221 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8955
Practice Address - Country:US
Practice Address - Phone:270-775-6060
Practice Address - Fax:270-339-7791
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015137363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300044645Medicaid
CS2035300109OtherCARESOURCE PROVIDER ID NUMBER
12078066OtherPRIME HEALTH SERVICES PROVIDER ID NUMBER
KY7100703790Medicaid
000001446476OtherANTHEM PIN
7557009OtherUNITED HEALTHCARE PROVIDER ID NUMBER