Provider Demographics
NPI:1639106719
Name:KAHRL, JENNIFER LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:KAHRL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1771 TATE BLVD SE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4250
Mailing Address - Country:US
Mailing Address - Phone:828-322-9105
Mailing Address - Fax:828-328-4999
Practice Address - Street 1:1771 TATE BLVD SE STE 204
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4250
Practice Address - Country:US
Practice Address - Phone:828-322-9105
Practice Address - Fax:828-328-4999
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06399363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00282664OtherRAILROAD MEDICARE
WV001722501OtherBLUE CROSS BLUE SHIELD
WV001722501OtherBLUE CROSS BLUE SHIELD
WVDAPA78221Medicare ID - Type Unspecified