Johnny Keith Coleman, P.A.-C.
Individual provider Active NPI Primary Care Nurse Practitioner · Fortuna, CA
NPI 1174558845 · NPPES record last updated Jun 30, 2015
Key facts
- NPI
- 1174558845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- PA13661 (CA)
- Practice address
- 3302 Renner Dr
Fortuna, CA 95540-7103 - Phone
- (707) 725-3318
- Fax
- (707) 725-9396
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13661 | CA | MD | Optometrist |
| PA13661 | CA | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Joseph Health Northern California, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | PA13661 | CA | Yes |
Addresses
Primary practice location
3302 Renner Dr
Fortuna, CA 95540-7103
Mailing address
3302 Renner Dr
Fortuna, CA 95540-3120
Phone (707) 725-3318
Other names
- John K Coleman
Other providers in Fortuna, CA
- Susie PA Cha
- Karen G Chase
- Hyun Ryung Choi
- Church of Loving Hands, Inc.
- Danielle Leighann Cole
- Jeffrey David Coutant
- Cowell Chiropractic Inc
- Michael Henry Crosbie
- Naomi E Cruz
- Lori Ann Cutler
All providers in Fortuna, CA · Primary Care Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.