Healthcare Provider Details

I. General information

NPI: 1528732062
Provider Name (Legal Business Name): TALON KOHLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W COUGAR BLVD STE 503
PROVO UT
84604-3323
US

IV. Provider business mailing address

395 W COUGAR BLVD STE 503
PROVO UT
84604-3323
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-9100
  • Fax:
Mailing address:
  • Phone: 801-374-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number12455920-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12455920-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: