Healthcare Provider Details

I. General information

NPI: 1720803059
Provider Name (Legal Business Name): MRS. KIRSTIE KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 7TH ST
MC COOK NE
69001-3079
US

IV. Provider business mailing address

700 W 7TH ST
MC COOK NE
69001-3079
US

V. Phone/Fax

Practice location:
  • Phone: 308-345-2510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: