Provider Demographics
NPI:1851027114
Name:RHODA, KOHLTON RILEY (APRN)
Entity Type:Individual
Prefix:
First Name:KOHLTON
Middle Name:RILEY
Last Name:RHODA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KOHLTON
Other - Middle Name:RILEY
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6330
Mailing Address - Country:US
Mailing Address - Phone:970-426-6287
Mailing Address - Fax:
Practice Address - Street 1:221 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6330
Practice Address - Country:US
Practice Address - Phone:970-426-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK192555363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health