Provider Demographics
NPI:1407388267
Name:COLEMAN, CAROLYN (FNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 GRANT AVE STE G
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6165
Mailing Address - Country:US
Mailing Address - Phone:870-493-3007
Mailing Address - Fax:870-330-9076
Practice Address - Street 1:1904 GRANT AVE STE G
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6165
Practice Address - Country:US
Practice Address - Phone:870-493-3007
Practice Address - Fax:870-330-9076
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22438363LF0000X
ARA005100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily