Provider Demographics
NPI:1194548727
Name:COFFIN, KELLY FAYE (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:FAYE
Last Name:COFFIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:FAYE
Other - Last Name:PIPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14468 N 66TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-4732
Mailing Address - Country:US
Mailing Address - Phone:970-210-4380
Mailing Address - Fax:
Practice Address - Street 1:14468 N 66TH EAST AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-4732
Practice Address - Country:US
Practice Address - Phone:970-210-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217388163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator