Provider Demographics
NPI:1548260417
Name:KOHLER, PATRICIA L (ANP-BC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:KOHLER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 BRECKINRIDGE BLVD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7612
Mailing Address - Country:US
Mailing Address - Phone:770-962-8396
Mailing Address - Fax:678-990-6429
Practice Address - Street 1:3075 BRECKINRIDGE BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7612
Practice Address - Country:US
Practice Address - Phone:770-962-8396
Practice Address - Fax:678-990-6429
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207747363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105347AMedicaid
GA1548260417Medicare PIN