Provider Demographics
NPI:1063147775
Name:COLEMAN, CHRYSTAL (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19310 VERDANT CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8670
Mailing Address - Country:US
Mailing Address - Phone:907-854-1917
Mailing Address - Fax:
Practice Address - Street 1:3340 PROVIDENCE DR STE 452
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4628
Practice Address - Country:US
Practice Address - Phone:907-562-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK196649363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics