Healthcare Provider Details

I. General information

NPI: 1053078899
Provider Name (Legal Business Name): CHARLES C KUHFAHL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N LINCOLN ST
GREENSBURG IN
47240-1348
US

IV. Provider business mailing address

8950 NINEVEH RD
NINEVEH IN
46164-9444
US

V. Phone/Fax

Practice location:
  • Phone: 812-222-3627
  • Fax:
Mailing address:
  • Phone: 812-371-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011960A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: