Provider Demographics
NPI:1881262780
Name:KOHLS, ALICIA (MSN, NPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KOHLS
Suffix:
Gender:F
Credentials:MSN, NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 E CAMELBACK RD STE 700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4245
Mailing Address - Country:US
Mailing Address - Phone:602-342-8418
Mailing Address - Fax:602-342-8328
Practice Address - Street 1:2415 E CAMELBACK RD STE 700
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4245
Practice Address - Country:US
Practice Address - Phone:602-342-8418
Practice Address - Fax:602-342-8328
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN208442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner