1295018430 NPI number — MRS. TERRA RACHELLE COLEMAN RN

Table of content: MRS. TERRA RACHELLE COLEMAN RN (NPI 1295018430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295018430 NPI number — MRS. TERRA RACHELLE COLEMAN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
TERRA
Provider Middle Name:
RACHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENBY
Provider Other First Name:
TERRA
Provider Other Middle Name:
RACHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295018430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S. PEORIA AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74120-3820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-588-1900
Provider Business Mailing Address Fax Number:
918-382-1285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 S PEORIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74120-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-382-1207
Provider Business Practice Location Address Fax Number:
918-382-1285
Provider Enumeration Date:
09/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

Other Provider's Identifiers (legacy, non-NPI)





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