Kenyetta Myshawn Coleman, ADMINISTRATOR

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

AS630405536 Issued in MI

Practice address

16087 Meadowood Ave
Southfield, MI 48076-4739

Phone

(248) 467-1142

NPI assigned

Apr 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kenyetta Coleman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1265012637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16087 MEADOWOOD AVE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480764739",
            "telephone_number": "248-467-1142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16087 MEADOWOOD AVE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480764739",
            "telephone_number": "248-467-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "KENYETTA",
        "middle_name": "MYSHAWN",
        "name_prefix": "Ms.",
        "credential": "ADMINISTRATOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-10",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": "MI",
            "license": "AS630405536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000000000",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENYETTA",
            "last_name": "COLEMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Victoria Marie Cohen, D.O.
• Gloria Colar
• Phaebre Colbert, MSW, LCSW
• Aiesha Coleman
• Hannah Coleman
• Sonya Coleman, LMSW
• Susan E Coleman, M.D.
• Trevor Coleman
• Rayna Simone Coles
• Collaborative Oasis DBT LLC

• Case Manager/Care Coordinator in Southfield, MI
• Providers in Southfield, MI by specialty
• Case Manager/Care Coordinator in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.