Provider Demographics
NPI:1336967553
Name:COLEMAN, PAULETTE L
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:L
Last Name:COLEMAN
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 1:412B FAWN TRL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1911
Mailing Address - Country:US
Mailing Address - Phone:430-215-6435
Mailing Address - Fax:
Practice Address - Street 1:412B FAWN TRL
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1911
Practice Address - Country:US
Practice Address - Phone:430-215-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator