Basic Information
| Provider Information | |||||||||
| NPI: | 1346373370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COHORN | ||||||||
| FirstName: | TONYA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4119 BROWNS LN | ||||||||
| Address2: | STE 1 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402201500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024519296 | ||||||||
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| Practice Location | |||||||||
| Address1: | 593 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406012332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022230308 | ||||||||
| FaxNumber: | 5022275764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA648 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 7100173200 | 05 | KY | MEDICAID |