Provider Demographics
NPI:1205804143
Name:KOHL, KRISTI S (MD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:S
Last Name:KOHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:WENDLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2114 N LINCOLN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1072
Mailing Address - Country:US
Mailing Address - Phone:402-362-0615
Mailing Address - Fax:
Practice Address - Street 1:2114 N LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1072
Practice Address - Country:US
Practice Address - Phone:402-362-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE476014365-00Medicaid
03324OtherBCBS
03324OtherBCBS
NE476014365-00Medicaid