Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R885333 | MS |
NPI | 1003153966 |
---|---|
Provider Name | Brittany Nicole Coleman |
First Address | Gulfport, MS 39505-2181 |
Second Address | Gulfport, MS 39503-2975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2013 |
Last Update Date | 12/01/2013 |