Provider Demographics
NPI:1952394348
Name:KOHNE, JED E (PA C)
Entity Type:Individual
Prefix:
First Name:JED
Middle Name:E
Last Name:KOHNE
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 S KNOXVILLE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2609
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-586-1257
Practice Address - Street 1:123 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1909
Practice Address - Country:US
Practice Address - Phone:419-586-5760
Practice Address - Fax:419-586-1257
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184652539OtherGROUP NPI
OH0105065OtherGROUP MEDICAID
OH0216503Medicaid
OH34-1689161OtherTAX ID
OH9934723OtherGROUP MEDICARE
OHH546170OtherMEDICARE