Provider Demographics
NPI:1841639374
Name:KOHN, ANDREA RENEE (LAC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:RENEE
Last Name:KOHN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:
Other - Last Name:KOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:9715 N FM 620
Mailing Address - Street 2:# 3207
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-2256
Mailing Address - Country:US
Mailing Address - Phone:512-940-8162
Mailing Address - Fax:
Practice Address - Street 1:13740 RESEARCH BLVD
Practice Address - Street 2:SUITE U-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1884
Practice Address - Country:US
Practice Address - Phone:512-335-5426
Practice Address - Fax:512-335-7462
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01387171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist