Basic Information
| Provider Information | |||||||||
| NPI: | 1902058308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOEHLER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | LILLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275466690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108934111 | ||||||||
| FaxNumber: | 9108939850 | ||||||||
| Practice Location | |||||||||
| Address1: | 4450 FAYETTEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276033612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197723154 | ||||||||
| FaxNumber: | 9108939850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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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 | 363A00000X | 001001539 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.