Healthcare Provider Details

I. General information

NPI: 1114993003
Provider Name (Legal Business Name): BARBARA RAE KOHUT RNCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EASTLAND AVE SE
WARREN OH
44484-4503
US

IV. Provider business mailing address

PO BOX 636988
CINCINNATI OH
45263-6988
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4177
  • Fax: 330-841-4598
Mailing address:
  • Phone: 888-940-2722
  • Fax: 513-632-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA01300NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: