Provider Demographics
NPI:1619431566
Name:KOHLMEIER, HEATH CHRISTIAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:CHRISTIAN
Last Name:KOHLMEIER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N MCCREARY ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRANCH
Mailing Address - State:IN
Mailing Address - Zip Code:47648-1313
Mailing Address - Country:US
Mailing Address - Phone:812-753-1039
Mailing Address - Fax:812-753-1122
Practice Address - Street 1:123 N MCCREARY ST
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648-1313
Practice Address - Country:US
Practice Address - Phone:812-753-1039
Practice Address - Fax:812-753-1122
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008712A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71008712AOtherLICENSE NUMBER