| Coffman Family Care And Wellness Pllc | |
|
1221 N Main St Beaver Dam KY 42320-8955 | |
| (270) 256-5911 | |
| Not Available |
| Full Name | Coffman Family Care And Wellness Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1221 N Main St, Beaver Dam, Kentucky |
| Authorized Official Name and Position | Angela Coffman (OWNER) |
| Authorized Official Contact | 2702565911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coffman Family Care And Wellness Pllc 1000 Thompson Dr Beaver Dam KY 42320-9152 Ph: (270) 256-5911 | Coffman Family Care And Wellness Pllc 1221 N Main St Beaver Dam KY 42320-8955 Ph: (270) 256-5911 |
| NPI Number | 1649997669 |
|---|---|
| Provider Enumeration Date | 10/20/2022 |
| Last Update Date | 10/20/2022 |
| Medicare PECOS PAC ID | 1759751456 |
|---|---|
| Medicare Enrollment ID | O20221221000317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649997669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Deborah S Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144461559 PECOS PAC ID: 5698828127 Enrollment ID: I20090731000321 |
| Provider Name | Angela Coffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811503410 PECOS PAC ID: 6406267707 Enrollment ID: I20201117002321 |
| Provider Name | Kendra Faith Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871204172 PECOS PAC ID: 4183095250 Enrollment ID: I20230127001759 |
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