Provider Demographics
NPI:1326876780
Name:COUGHLIN, KANSAS REBECCAMARIE
Entity type:Individual
Prefix:MRS
First Name:KANSAS
Middle Name:REBECCAMARIE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13183 EMERALD ISLE ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5343
Mailing Address - Country:US
Mailing Address - Phone:469-424-7711
Mailing Address - Fax:
Practice Address - Street 1:4950 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88008-9621
Practice Address - Country:US
Practice Address - Phone:575-882-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150952163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool