Provider Demographics
NPI:1538604657
Name:COLEMAN, COURTNEY L (APRN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LAYNE
Other - Last Name:FARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1029 MEDICAL CENTER CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1189
Mailing Address - Country:US
Mailing Address - Phone:270-251-4545
Mailing Address - Fax:270-251-4546
Practice Address - Street 1:1029 MEDICAL CENTER CIR STE 200
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-251-4545
Practice Address - Fax:270-251-4546
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily