Provider Demographics
NPI:1730955246
Name:KOHRT, TIA
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:KOHRT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-0506
Mailing Address - Country:US
Mailing Address - Phone:319-560-3474
Mailing Address - Fax:
Practice Address - Street 1:512 E GOLDFINCH DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-4706
Practice Address - Country:US
Practice Address - Phone:319-560-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG176029363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health