Individual
JOHNNY KEITH COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
3302 RENNER DR, FORTUNA, CA 95540-7103
(707) 725-3318
(707) 725-9396
Mailing address
3302 RENNER DR, FORTUNA, CA 95540-3120
(707) 725-3318
(707) 725-9396
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
PA13661
CA
Other
Enumeration date
07/11/2006
Last updated
06/30/2015
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