Provider Demographics
NPI:1518497338
Name:KAHLE, LAURETTA ACHA AMBE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURETTA
Middle Name:ACHA AMBE
Last Name:KAHLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURETTA
Other - Middle Name:ACHA
Other - Last Name:AMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:234 TOWNHOUSE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2374
Practice Address - Country:US
Practice Address - Phone:717-544-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA200001242363A00000X
PAMA059047363A00000X
MOPA200001242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant