Active NPI
Timothy John Coffman Sr., PA-C
- Medical Physician Assistant
- Las Vegas, NV
National Provider Identifier
1255308268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 024068
- Practice address
- 6900 North Pecos Rd
Las Vegas, NV 89084 - Phone
- (702) 719-9000
- Fax
- (702) 791-9359
- NPI assigned
- Mar 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 024068 | NY | Primary |
Addresses
Primary practice location
6900 North Pecos Rd
Las Vegas, NV 89084
Mailing address
904 Bluebird Hill Ave
North Las Vegas, NV 89084-2548
Phone (719) 337-6095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024068 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688688000000",
"number": "1255308268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 BLUEBIRD HILL AVE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890842548",
"telephone_number": "719-337-6095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 NORTH PECOS RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89084",
"telephone_number": "702-719-9000",
"fax_number": "702-791-9359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COFFMAN",
"first_name": "TIMOTHY",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-08",
"last_updated": "2023-07-07",
"certification_date": "2023-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "024068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.