Provider Demographics
NPI:1881944866
Name:COLEMAN, WINNIE HIBBLER
Entity type:Individual
Prefix:MRS
First Name:WINNIE
Middle Name:HIBBLER
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 1:74 BEAVERDAM RD
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2655
Mailing Address - Country:US
Mailing Address - Phone:662-207-9432
Mailing Address - Fax:
Practice Address - Street 1:216 FRONT STREET EXT
Practice Address - Street 2:74 BEAVERDAM ROAD
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2861
Practice Address - Country:US
Practice Address - Phone:662-207-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker