Provider Demographics
NPI:1992715940
Name:COLEMAN, LAURALEE C (PA-C)
Entity type:Individual
Prefix:
First Name:LAURALEE
Middle Name:C
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:101 STONECREST ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065
Mailing Address - Country:US
Mailing Address - Phone:502-633-5565
Mailing Address - Fax:502-633-5154
Practice Address - Street 1:101 STONECREST ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065
Practice Address - Country:US
Practice Address - Phone:502-633-5565
Practice Address - Fax:502-633-5154
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA204363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00546150Medicare Oscar/Certification