Provider Demographics
NPI:1346338589
Name:KAHLER, KIM W (APRN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:W
Last Name:KAHLER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4845
Mailing Address - Country:US
Mailing Address - Phone:574-533-7476
Mailing Address - Fax:574-533-7145
Practice Address - Street 1:1855 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4845
Practice Address - Country:US
Practice Address - Phone:574-533-7476
Practice Address - Fax:574-533-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002585A363LA2100X
NE110685363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200891730Medicaid
IN200891730Medicaid
IN184520TTTMedicare PIN