Provider Demographics
NPI:1497351548
Name:COLEMAN, KAYLA DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:DANIELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MONTICELLO AVE STE 1802
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2670
Mailing Address - Country:US
Mailing Address - Phone:804-596-2191
Mailing Address - Fax:
Practice Address - Street 1:440 MONTICELLO AVE STE 1802
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2670
Practice Address - Country:US
Practice Address - Phone:804-596-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24191804363LP0808X
VA0001279864163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health