Jake Thomas Coffman
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Fulton, MO
NPI 1487112678 · NPPES record last updated Mar 6, 2019
Key facts
- NPI
- 1487112678
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 3846 Saratoga CT
Fulton, MO 65251-3066 - Phone
- (573) 673-4157
- NPI assigned
- Mar 6, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
3846 Saratoga CT
Fulton, MO 65251-3066
Mailing address
3846 Saratoga CT
Fulton, MO 65251-3066
Phone (573) 673-4157
Other providers in Fulton, MO
- Cynthia L. Chalfant
- Dina Chaney-Goodin
- Changing Tides Behavioral Health, LLC
- Amanda Renee Chastain Graham
- Shaeana Lenae Cobbins
- Erica M Coil
- James Coleman
- Erin Lynn Collard
- Kayla Collier
- Community Health Ctr of Central Missouri
All providers in Fulton, MO · Student in an Organized Health Care Education/Training Program in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2019. 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.