| NPI | 1639524200 |
|---|---|
| Former Name | JESSICA JO COLEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-77249) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: KS 53-77249) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2020-03-09 |