Active NPI
Courtney Gayl Coleman, THW
- Community Health Worker
- Bend, OR
National Provider Identifier
1609609643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 112035
- Practice address
- 60575 Billadeau Rd
Bend, OR 97702-9338 - Phone
- (541) 389-1848
- Fax
- (541) 550-7956
- NPI assigned
- Aug 23, 2024
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 112035 | OR | Primary |
Addresses
Primary practice location
60575 Billadeau Rd
Bend, OR 97702-9338
Mailing address
60575 Billadeau Rd
Bend, OR 97702-9338
Phone (541) 389-1848
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112035 | OR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724371200000",
"number": "1609609643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60575 BILLADEAU RD",
"city": "BEND",
"state": "OR",
"postal_code": "977029338",
"telephone_number": "541-389-1848",
"fax_number": "541-550-7956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60575 BILLADEAU RD",
"city": "BEND",
"state": "OR",
"postal_code": "977029338",
"telephone_number": "541-389-1848",
"fax_number": "541-550-7956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEMAN",
"first_name": "COURTNEY",
"middle_name": "GAYL",
"credential": "THW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-23",
"last_updated": "2024-08-23",
"certification_date": "2024-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "112035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.