Provider Demographics
NPI:1720772932
Name:KAHLER, KOLLIN
Entity type:Individual
Prefix:
First Name:KOLLIN
Middle Name:
Last Name:KAHLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:ELM MOTT
Mailing Address - State:TX
Mailing Address - Zip Code:76640-3809
Mailing Address - Country:US
Mailing Address - Phone:254-723-0361
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-4930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine