Provider Demographics
NPI:1831752732
Name:COLEMAN, JOSHUA ALTON
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALTON
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9563
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-2563
Mailing Address - Country:US
Mailing Address - Phone:469-647-6835
Mailing Address - Fax:
Practice Address - Street 1:2830 W GRANDE BLVD APT# 2301
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75711-2563
Practice Address - Country:US
Practice Address - Phone:469-647-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324597164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse