Provider Demographics
NPI:1699760389
Name:KOHLHORST, GILLIAN (ARNP)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:KOHLHORST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5128
Mailing Address - Country:US
Mailing Address - Phone:620-275-1766
Mailing Address - Fax:
Practice Address - Street 1:712 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5128
Practice Address - Country:US
Practice Address - Phone:620-275-1766
Practice Address - Fax:620-275-4729
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160542OtherBC/BS PROVIDER NUMBER
KS160542OtherBC/BS PROVIDER NUMBER
KS171815Medicare PIN
KS171814Medicare PIN
KSP17971Medicare UPIN
KS171813Medicare PIN