Active NPI
Serena M Coulombe, CRNP
- Adult Health Nurse Practitioner
- Lagrange, GA
National Provider Identifier
1508802166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 51998
- Practice address
- Clark-Holder Clinic, P.a.
303 Smith Street
Lagrange, GA 30240 - Phone
- (706) 882-8831
- Fax
- (706) 812-4091
- NPI assigned
- Jun 21, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 51998 | GA | Primary |
Addresses
Primary practice location
Clark-Holder Clinic, P.a.
303 Smith Street
Lagrange, GA 30240
Mailing address
Clark-Holder Clinic, P.a.
303 Smith Street
Lagrange, GA 30240
Phone (706) 882-8831
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51998 | GA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508802166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CLARK-HOLDER CLINIC, P.A.",
"address_2": "303 SMITH STREET",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "30240",
"telephone_number": "706-882-8831",
"fax_number": "706-812-4091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CLARK-HOLDER CLINIC, P.A.",
"address_2": "303 SMITH STREET",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "30240",
"telephone_number": "706-882-8831",
"fax_number": "706-812-4091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COULOMBE",
"first_name": "SERENA",
"middle_name": "M",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "GA",
"license": "51998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lagrange, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.