Provider Demographics
NPI:1316274814
Name:WILLIAMS COLEMAN, BEVERLY R (APRN)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:R
Last Name:WILLIAMS COLEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S FLOYD ST OFC 4050
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3822
Mailing Address - Country:US
Mailing Address - Phone:502-852-0830
Mailing Address - Fax:
Practice Address - Street 1:2237 HIKES LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2203
Practice Address - Country:US
Practice Address - Phone:502-479-8390
Practice Address - Fax:502-479-8934
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100201260Medicaid
KYK000220Medicare PIN