Healthcare Provider Details

I. General information

NPI: 1649150566
Provider Name (Legal Business Name): EMMA KOCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 N WEBB RD
WICHITA KS
67226-8119
US

IV. Provider business mailing address

1320 N MOUNT CARMEL CIR
WICHITA KS
67203-6653
US

V. Phone/Fax

Practice location:
  • Phone: 316-261-3130
  • Fax:
Mailing address:
  • Phone: 785-764-3430
  • 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: