Provider Demographics
NPI:1023345204
Name:COLEMAN, NELDA K (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:NELDA
Middle Name:K
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-6415
Mailing Address - Country:US
Mailing Address - Phone:940-553-4776
Mailing Address - Fax:
Practice Address - Street 1:4715 VIEWRIDGE AVENUE
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-454-3610
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233465363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health