Healthcare Provider Details

I. General information

NPI: 1962313692
Provider Name (Legal Business Name): RYAN NICOLE KOCH PSY, D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 HIGH HOUSE RD # 4399
CARY NC
27513-3574
US

IV. Provider business mailing address

964 HIGH HOUSE RD # 4399
CARY NC
27513-3574
US

V. Phone/Fax

Practice location:
  • Phone: 919-443-5133
  • Fax:
Mailing address:
  • Phone: 919-443-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5711
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: