KELLY MARCUS COLEMAN (NPI# 1629395454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629395454 |
| Entity Type | Individual |
| Full Name | KELLY MARCUS COLEMAN |
| Credential | M.D. |
| Practice Address |
6300 E Lake Blvd Ste 201 Vancleave MS 39565-6771 |
| Mailing Address |
6300 E Lake Blvd Ste 301 Vancleave MS 39565-6771 |
| Practice Telephone | 2282302663 |
| Practice Fax Number | 2285463257 |
| Mailing Telephone | 2282302663 |
| Mailing Fax Number | 2285463257 |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2018-09-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | 25293 | MS | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
25293 | MS | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033660089 | Kelly Coleman | Specialist/Technologist | 160 Windermere Ave Apt 4603, Ellington, CT 06029-3949 | 2016-10-14 |
| 1093332363 | Kelly Ann Coleman | Behavior Technician | 11450 N Meridian St Ste 100, Carmel, IN 46032-4688 | 2020-07-02 |
| 1053890301 | Kelly Marie Coleman | Physical Therapist | 168 Industrial Dr Unit 5, Mashpee, MA 02649-3562 | 2018-08-08 |
| 1245721182 | Kelly Coleman | Psychologist | 162 Main St, Hamburg, NY 14075-4917 | 2018-05-26 |
| 1497107536 | Kelly J Coleman | Nurse Practitioner | 1718 E 4th St, Suite 501, Charlotte, NC 28204-3261 | 2016-07-12 |
| 1174980437 | Kelly Coleman | Clinical Nurse Specialist | 7800 Shoal Creek Blvd Ste 130w, Austin, TX 78757 | 2016-01-18 |
| 1407189756 | Kelly K Coleman | Psychologist | 801 Broadway, Suite 800, Seattle, WA 98122-4396 | 2009-09-17 |
| 1760635122 | Kelly Lynn Coleman | Physical Therapist | 250 Hospital Pkwy, San Jose, CA 95119-1103 | 2008-10-29 |
| 1982863353 | Kelly Alan Coleman | Physical Therapist | 1342 E Primrose Street, Suite A, Springfield, MO 65804-4224 | 2008-06-02 |
| 1396929865 | Kelly Ann Coleman | Counselor | 1460 Livingston Ave, North Brunswick, NJ 08902-1873 | 2007-12-20 |
| Street Address |
6300 E LAKE BLVD STE 201 |
| City | VANCLEAVE |
| State | MS |
| Zip Code | 39565-6771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619919156 | Lennon E. Bowen Iv | Psychiatry & Neurology | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565 | 2006-06-11 |
| 1588139521 | Carolyn Lawson | Occupational Therapist | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565-6771 | 2018-10-05 |
| 1396233490 | Dorian R Blake | Nurse Practitioner | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565 | 2018-04-25 |
| 1629427174 | Amanda Rayburn | Registered Nurse | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565 | 2016-06-06 |
| 1598185563 | Thomas Jordan Lucak | Orthopaedic Surgery | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565-6771 | 2014-04-17 |
| 1699031369 | Jess Harding Mullens | Orthopaedic Surgery | 6300 E Lake Blvd Ste 201, Vancleave, MS 39565 | 2012-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548761950 | Jake Wallace Carzoli | Nurse Practitioner | 11700 Ms-57, Vancleave, MS 39565 | 2018-02-22 |
| 1992129316 | Ashlynn Evan Crum | Speech-Language Pathologist | 8728 Doobie Ct., Vancleave, MS 39565 | 2014-02-05 |
| 1851695720 | Coast Nurse Practitioners, Inc. | Nurse Practitioner | 13300 R.s. Kimball Road, Vancleave, MS 39565 | 2011-01-06 |
| 1538484761 | Sarah Burke | Speech-Language Pathologist | 477 Colonel Vickrey Road, Vancleave, MS 39565 | 2010-03-31 |
| 1194058842 | Jackson County School District | Local Education Agency (LEA) | 4700 Colonel Vickrey Road, Vancleave, MS 39565 | 2009-09-14 |
| 1962566224 | John Michael Martin | Nurse Practitioner | 1330 R S Kimball, Vancleave, MS 39565 | 2006-12-21 |
| 1164971867 | Clarissa Picard | Occupational Therapist | 6300 East Lake Blvd., Suite 301, Vancleave, MS 39565 | 2016-09-23 |
| 1760707913 | Maryann Meehan | Speech-Language Pathologist | 477 Colonel Vickrey Road, Vancleave, MS 39565 | 2010-03-31 |
| 1306161559 | Michael Pavlov | Psychologist | 477 Colonel Vickrey Road, Vancleave, MS 39565 | 2010-03-31 |
| 1184949356 | Jayme Robinson | Occupational Therapist | 4700 Colonel Vickrey Road, Vancleave, MS 39565 | 2010-03-31 |
| Find all providers in zip 39565 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639317274 | Robert A Wiemer Jr. | Pain Medicine | 528-f Klondike Road, Long Beach, MS 39560 | 2009-02-03 |
| 1922218627 | Robert Fortier Bensen | Pain Medicine | 445 Security Sq, Gulfport, MS 39507-1922 | 2007-05-23 |
| 1811098874 | Laurel Pain Clinic Pa | Pain Medicine | 1706 W 12th St, Laurel, MS 39440-2559 | 2006-09-25 |
| 1922092881 | Eric Pearson | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2005-09-07 |
| 1497752760 | Fani B Manney | Pain Medicine | #4 Doctors Dr, Suite C, Ocean Springs, MS 39564 | 2005-07-01 |
| 1417953050 | Steven Thomas Richey | Pain Medicine | 122 Airways Pl, Southaven, MS 38671-5872 | 2005-06-27 |
| 1316558893 | Mississippi Pain Management, Pllc | Pain Medicine | 1080 River Oaks Dr Ste B103, Flowood, MS 39232-7602 | 2020-08-10 |
| 1083193031 | Bacas Interventional Pain Management, LLC | Pain Medicine | 1430 Highway 4 E, Holly Springs, MS 38635-2140 | 2018-08-10 |
| 1356848014 | Flowood Pain Center, LLC | Pain Medicine | 120 Stone Creek Blvd Ste 500, Flowood, MS 39232-8210 | 2018-04-10 |
| 1134596760 | Pain Partners, LLC | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2015-08-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.