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General NPI Number Information
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NPI Number | 1164032355
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Entity Type | Individual
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Provider Name | KRISTOPHER RYAN KOHOUT
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Gender | Male
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1115 E TYLER ST
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City | ATHENS
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State | TX
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Zip | 75751-2145
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Country | US
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Telephone | 903-292-5015
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Fax | 903-292-5021
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Provider Business Mailing Address
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Address Line | PO BOX 95559
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City | GRAPEVINE
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State | TX
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Zip | 76099-9707
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Country | US
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Telephone | 405-724-0574
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Fax | 405-849-4105
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17918
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License Number State | TX
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