Provider Demographics
NPI:1912383522
Name:KOHLER, GREGORY MICHAEL (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:KOHLER
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1351
Mailing Address - Country:US
Mailing Address - Phone:623-824-4584
Mailing Address - Fax:
Practice Address - Street 1:6036 N 19TH AVE STE 505
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2143
Practice Address - Country:US
Practice Address - Phone:602-249-0839
Practice Address - Fax:602-249-8566
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8009363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care