Provider Demographics
NPI:1154874543
Name:KOHL, MEGHAN ANDREA (NP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANDREA
Last Name:KOHL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-9543
Mailing Address - Country:US
Mailing Address - Phone:910-904-1276
Mailing Address - Fax:910-904-1767
Practice Address - Street 1:929 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-9543
Practice Address - Country:US
Practice Address - Phone:910-904-1276
Practice Address - Fax:910-904-1767
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF06162019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily