Healthcare Provider Details

I. General information

NPI: 1427418417
Provider Name (Legal Business Name): MITCHEL KOHNEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PATIENTS FIRST DR STE 1300
WASHINGTON MO
63090-4700
US

IV. Provider business mailing address

901 PATIENTS FIRST DR STE 1300
WASHINGTON MO
63090-4700
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-9011
  • Fax:
Mailing address:
  • Phone: 636-239-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2016006624
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: