Individual provider Active NPI

Laura Coulson, CRNP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1679231138
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP024407 Issued in PA
Practice address
161 Cecil B Moore Ave Apt 204
Philadelphia, PA 19122-3243
Phone
(215) 585-2144
Fax
(267) 780-7032
NPI assigned
Dec 2, 2021
Last updated
Mar 31, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP024407 PA Primary

Addresses

Primary practice location

161 Cecil B Moore Ave Apt 204
Philadelphia, PA 19122-3243

Mailing address

161 Cecil B Moore Ave Apt 204
Philadelphia, PA 19122-3243
Phone (215) 585-2144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, FL, ME3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20211210000335 PA Practitioner - Nurse Practitioner 9133519937 Reassigns benefits to 1 organization
I20221011002998 FL Practitioner - Nurse Practitioner 9133519937 Reassigns benefits to 1 organization
I20240205003577 ME Practitioner - Nurse Practitioner 9133519937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ophelia Medical Group FL PAGroup PAC ID 7810398534, 103 clinicians

Practice addresses (Care Compare)

161 Cecil B Moore Ave
Apt 204
Philadelphia, PA 19122-3243
Phone (215) 585-2144

500 Forest Ave
Suite 1C
Portland, ME 04101-1523
Phone (215) 585-2144

801 W Bay Dr
Suite 408
Largo, FL 33770-3220
Phone (215) 585-2144

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP024407PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ophelia Medical Group, P.C. CurrentSince Dec 6, 2021 Accepting new patients
Ophelia Medical Group FL, P.a. CurrentSince Dec 6, 2021 Accepting new patients

Locations

801 West Bay Dr
Ste 408
Largo, FL 33770

500 Forest Ave
Ste 1C
Portland, ME 04101

228 Park Ave S
New York, NY 10003
Phone (215) 588-2144

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1679231138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 CECIL B MOORE AVE APT 204",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191223243",
            "telephone_number": "215-585-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 CECIL B MOORE AVE APT 204",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191223243",
            "telephone_number": "215-585-2144",
            "fax_number": "267-780-7032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULSON",
        "first_name": "LAURA",
        "name_prefix": "Miss",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-02",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP024407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.