Individual
MRS. HEATHER J KOHOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8550 W 38TH AVE STE 300, WHEAT RIDGE, CO 80033-4355
(303) 463-3900
(303) 423-2621
Mailing address
8550 W 38TH AVE STE 300, WHEAT RIDGE, CO 80033-4355
(303) 463-3900
(303) 423-2621
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085002714
IL
363A00000X
Physician Assistant
3430
CO
363A00000X
Physician Assistant
Primary
85002714
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
371221637
FEDERAL TAX ID
IL
01
—
776530
MEDICARE GROUP PIN
—
01
—
809840
MEDICARE GROUP
IL
01
—
CA4079
RR MEDICARE GROUP PTAN
IL
01
—
P00680137
RR MEDICARE MEMBER PTAN
IL
Enumeration date
05/18/2006
Last updated
12/13/2021
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