Provider Demographics
NPI:1053647768
Name:KOHLER, LEORA LYNN (LSA)
Entity Type:Individual
Prefix:
First Name:LEORA
Middle Name:LYNN
Last Name:KOHLER
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:LEORA
Other - Middle Name:
Other - Last Name:BENESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SA-C
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0492
Mailing Address - Country:US
Mailing Address - Phone:972-442-9065
Mailing Address - Fax:972-442-9905
Practice Address - Street 1:1901 MILLER RD
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5604
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09-268246ZC0007X, 246ZS0410X
IL09-268246ZS0410X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist