Basic Information
| Provider Information | |||||||||
| NPI: | 1619431566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOHLMEIER | ||||||||
| FirstName: | HEATH | ||||||||
| MiddleName: | CHRISTIAN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 N MCCREARY ST | ||||||||
| Address2: | |||||||||
| City: | FORT BRANCH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476481313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127531039 | ||||||||
| FaxNumber: | 8127531122 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 N MCCREARY ST | ||||||||
| Address2: | |||||||||
| City: | FORT BRANCH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476481313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127531039 | ||||||||
| FaxNumber: | 8127531122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71008712A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 71008712A | 01 | IN | LICENSE NUMBER | OTHER |