Provider Demographics
NPI:1366605446
Name:COFFMAN, SHEILA MARIE (PA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2339
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-2339
Mailing Address - Country:US
Mailing Address - Phone:580-225-2513
Mailing Address - Fax:580-303-5863
Practice Address - Street 1:1901 W 3RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4337
Practice Address - Country:US
Practice Address - Phone:580-225-2513
Practice Address - Fax:580-303-5863
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK346363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical