Healthcare Provider Details

I. General information

NPI: 1609607688
Provider Name (Legal Business Name): KAYLEIGH KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

1200 SOMERBY DR APT 1916
MOBILE AL
36695-5448
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-1000
  • Fax:
Mailing address:
  • Phone: 256-702-1752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: