Provider Demographics
NPI:1518497338
Name:KAHLE, LAURETTA A (PA-C)
Entity type:Individual
Prefix:
First Name:LAURETTA
Middle Name:A
Last Name:KAHLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURETTA
Other - Middle Name:ACHA
Other - Last Name:AMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 AUTUMN OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-2801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44045 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5101
Practice Address - Country:US
Practice Address - Phone:703-858-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA200001242363A00000X
PAMA059047363A00000X
MOPA200001242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant