Healthcare Provider Details

I. General information

NPI: 1215453063
Provider Name (Legal Business Name): CAROLINE JADE KOCH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLINE KOCH STITES MS, LCGC

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST
BATON ROUGE LA
70817-5127
US

IV. Provider business mailing address

500 RUE DE LA VIE ST STE 305
BATON ROUGE LA
70817-5128
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: