Provider Demographics
NPI:1871674242
Name:HOHLEN, KELLY I (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:I
Last Name:HOHLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4954
Mailing Address - Country:US
Mailing Address - Phone:308-398-1344
Mailing Address - Fax:308-398-1346
Practice Address - Street 1:730 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4954
Practice Address - Country:US
Practice Address - Phone:308-398-1344
Practice Address - Fax:308-398-1346
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1230363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096576007Medicare PIN
NE099790005Medicare PIN