1841237294 NPI number — KAREN ALYCE COLEMAN PA-C

Table of content: KAREN ALYCE COLEMAN PA-C (NPI 1841237294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841237294 NPI number — KAREN ALYCE COLEMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
KAREN
Provider Middle Name:
ALYCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIEFFER
Provider Other First Name:
KAREN
Provider Other Middle Name:
ALYCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841237294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2946 E. BANNER GATEWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-256-6444
Provider Business Mailing Address Fax Number:
480-256-3682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2946 E. BANNER GATEWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-406-4000
Provider Business Practice Location Address Fax Number:
602-406-6498
Provider Enumeration Date:
06/01/2006

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

  • Taxonomy code: 363A00000X , with the licence number:  3133 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 3133 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 3133 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5550830003 . This is a "MEDICARE NSC PEORIA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830006 . This is a "MEDICARE NSC ANTHEM" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830008 . This is a "MEDICARE NSC SWV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830010 . This is a "MEDICARE NSC GILBERT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830004 . This is a "MEDICARE NSC PV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830009 . This is a "MEDICARE NSC AZ NORTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 906480 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00214608 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830007 . This is a "MEDICARE NSC DV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830001 . This is a "MEDICARE NSC SCW" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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