Provider Demographics
NPI:1730664723
Name:KAHL, KATRIN JOHANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRIN
Middle Name:JOHANNA
Last Name:KAHL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 HIGHWAY 95 STE 107B
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4339
Mailing Address - Country:US
Mailing Address - Phone:928-763-0433
Mailing Address - Fax:928-763-0839
Practice Address - Street 1:3015 HIGHWAY 95 STE 107B
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4339
Practice Address - Country:US
Practice Address - Phone:928-763-0433
Practice Address - Fax:928-763-0839
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant