Healthcare Provider Details

I. General information

NPI: 1467251066
Provider Name (Legal Business Name): HOMER COUCH APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 E COLLEGE AVE STE B
STANTON KY
40380-2363
US

IV. Provider business mailing address

PO BOX 286
LOST CREEK KY
41348-0286
US

V. Phone/Fax

Practice location:
  • Phone: 606-318-3500
  • Fax: 606-318-3503
Mailing address:
  • Phone: 606-309-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4036163
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: