Active NPI
Pamela R Koehler, PA
- Medical Physician Assistant
- Fort Bragg, CA
National Provider Identifier
1255651063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 13556
- Practice address
- 721A River Dr
Fort Bragg, CA 95437-5402 - Phone
- (707) 964-1192
- Fax
- (707) 964-4631
- NPI assigned
- Jun 3, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 13556 | CA | Primary |
Addresses
Primary practice location
721A River Dr
Fort Bragg, CA 95437-5402
Mailing address
721 River Drive
Suite a
Fort Bragg, CA 95437-0000
Phone (707) 964-1192
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13556 | CA | MD | Pain Medicine (Anesthesiology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275523200000",
"number": "1255651063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 RIVER DRIVE",
"address_2": "SUITE A",
"city": "FORT BRAGG",
"state": "CA",
"postal_code": "954370000",
"telephone_number": "707-964-1192",
"fax_number": "707-964-4631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721A RIVER DR",
"city": "FORT BRAGG",
"state": "CA",
"postal_code": "954375402",
"telephone_number": "707-964-1192",
"fax_number": "707-964-4631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEHLER",
"first_name": "PAMELA",
"middle_name": "R",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-03",
"last_updated": "2010-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "13556",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.