Provider Demographics
NPI:1225566433
Name:KAHLE, LAURA MARKS (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARKS
Last Name:KAHLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 KIEFER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7381
Mailing Address - Country:US
Mailing Address - Phone:501-310-6789
Mailing Address - Fax:
Practice Address - Street 1:9701 LANDMARK PARKWAY DR STE 207
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1665
Practice Address - Country:US
Practice Address - Phone:317-849-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant