Provider Demographics
NPI:1588438840
Name:COLEMAN, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BRADSHAW
Mailing Address - State:WV
Mailing Address - Zip Code:24817-0293
Mailing Address - Country:US
Mailing Address - Phone:276-245-2852
Mailing Address - Fax:304-938-6124
Practice Address - Street 1:2657 RAYSAL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:RAYSAL
Practice Address - State:WV
Practice Address - Zip Code:24879-8115
Practice Address - Country:US
Practice Address - Phone:276-245-2852
Practice Address - Fax:304-938-6124
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV120420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily