Provider Demographics
NPI:1558062786
Name:POEHLMANN, KAYLIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:POEHLMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLIE
Other - Middle Name:
Other - Last Name:ANGUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7217 WATER MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2826
Mailing Address - Country:US
Mailing Address - Phone:970-396-7764
Mailing Address - Fax:
Practice Address - Street 1:7217 WATER MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2826
Practice Address - Country:US
Practice Address - Phone:970-396-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant