Provider Demographics
NPI:1366765679
Name:KOHLER, KRISTIN ALYSSE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ALYSSE
Last Name:KOHLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ALYSSE
Other - Last Name:EMANUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:227 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2001
Mailing Address - Country:US
Mailing Address - Phone:410-332-9294
Mailing Address - Fax:410-332-9731
Practice Address - Street 1:227 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2001
Practice Address - Country:US
Practice Address - Phone:410-332-9294
Practice Address - Fax:410-332-9731
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04810363A00000X
NJ25MP00232700363AM0700X
MDC0004810363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant