Healthcare Provider Details

I. General information

NPI: 1124728050
Provider Name (Legal Business Name): SARAH A KOEHLER AGPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 SHERMAN DR
PRINCETON IN
47670-1043
US

IV. Provider business mailing address

12422 ROLLING MEADOWS DR
EVANSVILLE IN
47725-8180
US

V. Phone/Fax

Practice location:
  • Phone: 812-385-1701
  • Fax:
Mailing address:
  • Phone: 901-604-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28211246A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013791A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number28211246A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4008828
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: