Provider Demographics
NPI:1982216156
Name:VON KOLEN, KARA (DNP, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:VON KOLEN
Suffix:
Gender:F
Credentials:DNP, WHNP-BC
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:LARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, WHNP-BC
Mailing Address - Street 1:303 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6530
Mailing Address - Country:US
Mailing Address - Phone:602-243-7277
Mailing Address - Fax:602-243-5019
Practice Address - Street 1:303 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6530
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-243-5019
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245129363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1982216156Medicaid