Healthcare Provider Details

I. General information

NPI: 1437451168
Provider Name (Legal Business Name): KEVIN J KOCH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N 29TH ST
BILLINGS MT
59101-0731
US

IV. Provider business mailing address

1041 N 29TH ST
BILLINGS MT
59101-0731
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5577
  • Fax:
Mailing address:
  • Phone: 406-237-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number26691
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number103781
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: