Healthcare Provider Details

I. General information

NPI: 1386740892
Provider Name (Legal Business Name): MICHELLE LYNNE KOCH ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE L. KOCH-SHAMBURG APRN-C

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 GOLDFINCH RD
HORTON KS
66439-9537
US

IV. Provider business mailing address

800 RAVEN HILL DRIVE
ATCHISON KS
66002
US

V. Phone/Fax

Practice location:
  • Phone: 785-486-2154
  • Fax:
Mailing address:
  • Phone: 913-367-2131
  • Fax: 913-674-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45193
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: