Provider Demographics
NPI:1952782393
Name:COLEMAN, KAYLEEN M (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:M
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6932 WILLIAMS RD
Mailing Address - Street 2:STE 1600
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3072
Mailing Address - Country:US
Mailing Address - Phone:716-564-2273
Mailing Address - Fax:716-564-2272
Practice Address - Street 1:2099 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3518
Practice Address - Country:US
Practice Address - Phone:716-564-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018689363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical