Healthcare Provider Details

I. General information

NPI: 1881262780
Provider Name (Legal Business Name): ALICIA KOHLS MSN, NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

IV. Provider business mailing address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

V. Phone/Fax

Practice location:
  • Phone: 602-342-8418
  • Fax: 602-342-8328
Mailing address:
  • Phone: 602-342-8418
  • Fax: 602-342-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN208442
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: