Provider Demographics
NPI:1255651063
Name:KOEHLER, PAMELA R (PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:721 RIVER DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-0000
Mailing Address - Country:US
Mailing Address - Phone:707-964-1192
Mailing Address - Fax:707-964-4631
Practice Address - Street 1:721A RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5402
Practice Address - Country:US
Practice Address - Phone:707-964-1192
Practice Address - Fax:707-964-4631
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13556363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical