=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437397015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LADONNA SUE KOEHN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2009
-----------------------------------------------------
Last Update Date | 02/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 6TH ST SW
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-8530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-785-4561
-----------------------------------------------------
Fax | 903-737-9924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3580 COUNTY ROAD 2127 N
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75436-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-674-4436
-----------------------------------------------------
Fax | 903-674-4436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 447424
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------