Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 772479 | TX |
NPI | 1003356825 |
---|---|
Provider Name | Melissa Coltman |
First Address | Plano, TX 75093-5362 |
Second Address | Plano, TX 75093-5362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 04/06/2020 |