Provider Demographics
NPI:1548948029
Name:KAHLE, KRISTA JADE (CNM)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:JADE
Last Name:KAHLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 919771
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9771
Mailing Address - Country:US
Mailing Address - Phone:393-442-3912
Mailing Address - Fax:
Practice Address - Street 1:11100 SUMMER RIDGE LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4064
Practice Address - Country:US
Practice Address - Phone:239-344-2362
Practice Address - Fax:239-479-5202
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027311367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty