MEDICARE: KRISTINA KOHUTH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0010-08570	NC
2	363A00000X	Physician Assistant	0010-08570	NC

General Provider Information

NPI Number	:	1104392588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA KOHUTH PA-C

Provider Business Mailing Address
First Line	:	3001 EDWARDS MILL RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5243
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:	919-576-1731

Provider Business Practice Location Address
First Line	:	3001 EDWARDS MILL RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5243
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	04/03/2026

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