Provider Demographics
NPI:1467193615
Name:KAUFFELD, COLE
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:KAUFFELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19929 HIGHWAY 123
Mailing Address - Street 2:
Mailing Address - City:HAGARVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72839-9326
Mailing Address - Country:US
Mailing Address - Phone:479-214-3896
Mailing Address - Fax:
Practice Address - Street 1:19929 HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:HAGARVILLE
Practice Address - State:AR
Practice Address - Zip Code:72839-9326
Practice Address - Country:US
Practice Address - Phone:479-214-3896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant