Provider Demographics
NPI:1023101995
Name:KOLLER, PATRICIA A (APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:KOLLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:114 E MCMURTRY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1614
Practice Address - Country:US
Practice Address - Phone:270-298-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4717P363L00000X
KY3004717363LF0000X
IN71005879A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000001071134OtherANTHEM-NHC
KY115190OtherSIHO-NHC
KY78015211Medicaid
KYK151441Medicare PIN
KY000001071134OtherANTHEM-NHC