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General NPI Number Information
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NPI Number | 1104392588
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Entity Type | Individual
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Provider Name | KRISTINA KOHUTH PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 421 FAYETTEVILLE ST STE 1100
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City | RALEIGH
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State | NC
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Zip | 27601-3000
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Country | US
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Telephone | 919-858-6767
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Fax | 919-576-1731
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Provider Business Mailing Address
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Address Line | 421 FAYETTEVILLE ST STE 1100
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City | RALEIGH
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State | NC
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Zip | 27601-3000
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Country | US
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Telephone | 772-486-0807
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Fax | 919-576-1731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0010-08570
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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