Provider Demographics
NPI:1437397015
Name:KOEHN, LADONNA SUE
Entity Type:Individual
Prefix:MRS
First Name:LADONNA
Middle Name:SUE
Last Name:KOEHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 COUNTY ROAD 2127 N
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:TX
Mailing Address - Zip Code:75436-4019
Mailing Address - Country:US
Mailing Address - Phone:903-674-4436
Mailing Address - Fax:903-674-4436
Practice Address - Street 1:740 6TH ST SW
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-8530
Practice Address - Country:US
Practice Address - Phone:903-785-4561
Practice Address - Fax:903-737-9924
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX447424363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care