Provider Demographics
NPI:1801353503
Name:KOEN, THOMAS ALEXANDER (APRN,AGNP-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALEXANDER
Last Name:KOEN
Suffix:
Gender:M
Credentials:APRN,AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:888-973-8821
Practice Address - Street 1:1 PERIMETER PARK S STE 195A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2327
Practice Address - Country:US
Practice Address - Phone:668-490-6928
Practice Address - Fax:888-973-8821
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029288363L00000X
TN35665363L00000X
NC5020445363L00000X
SC28796363L00000X
OHAPRN.CNP.0037904363L00000X
TX1178922363L00000X
AL1128686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner