Provider Demographics
NPI:1902379613
Name:COHOON, KARRON LEIGH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KARRON
Middle Name:LEIGH
Last Name:COHOON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KARRON
Other - Middle Name:LEIGH
Other - Last Name:GILMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KARRON GILMER, RN
Mailing Address - Street 1:1010 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-1905
Mailing Address - Country:US
Mailing Address - Phone:605-961-5593
Mailing Address - Fax:
Practice Address - Street 1:1010 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1905
Practice Address - Country:US
Practice Address - Phone:605-961-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9121363LP0808X
MN10273363LP0808X, 363LP2300X
SDCP002428363LP2300X, 363LP0808X
WI8964363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care