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General NPI Number Information
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NPI Number | 1730955246
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Entity Type | Individual
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Provider Name | TIA KOHRT
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 512 E GOLDFINCH DR
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City | TIFFIN
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State | IA
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Zip | 52340-4706
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Country | US
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Telephone | 319-560-3474
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 506
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City | TIFFIN
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State | IA
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Zip | 52340-0506
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Country | US
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Telephone | 319-560-3474
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | G176029
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License Number State | IA
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