Healthcare Provider Details

I. General information

NPI: 1821676669
Provider Name (Legal Business Name): ANTHONY KOCH PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6923 GIBSON RD
CANFIELD OH
44406-8653
US

IV. Provider business mailing address

6923 GIBSON RD
CANFIELD OH
44406-8653
US

V. Phone/Fax

Practice location:
  • Phone: 330-398-1132
  • Fax:
Mailing address:
  • Phone: 330-398-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN61287688
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.445266
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0029697
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61289252
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNPF95024532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: