Provider Demographics
NPI:1962163881
Name:KAHL, AMMIE EDEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMMIE
Middle Name:EDEN
Last Name:KAHL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 ELIZONDO AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4711
Mailing Address - Country:US
Mailing Address - Phone:805-587-4908
Mailing Address - Fax:
Practice Address - Street 1:1000 NEWBURY RD STE 210
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6441
Practice Address - Country:US
Practice Address - Phone:805-214-9990
Practice Address - Fax:805-214-9930
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily