Healthcare Provider Details

I. General information

NPI: 1003870817
Provider Name (Legal Business Name): CARRIE E COHEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S ASH ST
MCPHERSON KS
67460-4801
US

IV. Provider business mailing address

113 S ASH ST
WICHITA KS
67203-4937
US

V. Phone/Fax

Practice location:
  • Phone: 844-588-7223
  • Fax: 844-873-0149
Mailing address:
  • Phone: 844-588-7223
  • Fax: 844-873-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0530647
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: