Individual
MR. BLAKE T COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
3901 RAINBOW BLVD, MS1020, KANSAS CITY, KS 66160
(913) 588-3807
(913) 588-3877
Mailing address
3804 NW 52ND TERRACE, KANSAS CITY, MO 64151
(816) 830-5042
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
75958
KS
363LF0000X
Family Nurse Practitioner
2005007561
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00976936
RAILROAD MEDICARE PTAN
MO
Enumeration date
02/23/2010
Last updated
07/19/2017
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