Provider Demographics
NPI:1952864175
Name:COLEMAN, KELLI (MD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3907
Mailing Address - Country:US
Mailing Address - Phone:318-212-2020
Mailing Address - Fax:318-212-6336
Practice Address - Street 1:2611 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3907
Practice Address - Country:US
Practice Address - Phone:318-212-2020
Practice Address - Fax:318-212-6336
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161177207W00000X
LA323653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology