Healthcare Provider Details

I. General information

NPI: 1093430019
Provider Name (Legal Business Name): JESSICA KOCH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 SULLIVAN TRL
EASTON PA
18040-8339
US

IV. Provider business mailing address

2003 SULLIVAN TRL
EASTON PA
18040-8339
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-6470
  • Fax:
Mailing address:
  • Phone: 484-503-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP026428
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: