Healthcare Provider Details

I. General information

NPI: 1467280610
Provider Name (Legal Business Name): JOSEPH KOHOUT FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH KOHOUT FNP-C

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1011
FLAGSTAFF AZ
86002-1011
US

IV. Provider business mailing address

PO BOX 1011
FLAGSTAFF AZ
86002-1011
US

V. Phone/Fax

Practice location:
  • Phone: 520-491-0122
  • Fax:
Mailing address:
  • Phone: 520-491-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number329802
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN169463
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: