MEDICARE: MRS. ASHLY JULIET KOEHLER MSN, APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	828341	NV

General Provider Information

NPI Number	:	1326679572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLY JULIET KOEHLER MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	320 E WARM SPRINGS RD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4242
Country	:	US
Telephone Number	:	702-602-5250
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 E WARM SPRINGS RD UNIT 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4243
Country	:	US
Telephone Number	:	702-602-5250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	04/20/2020

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