Provider Demographics
NPI:1447859962
Name:COFFMAN, JENNA LEIGH
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-9711
Mailing Address - Country:US
Mailing Address - Phone:304-790-1560
Mailing Address - Fax:
Practice Address - Street 1:3310 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9711
Practice Address - Country:US
Practice Address - Phone:304-790-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant