Healthcare Provider Details

I. General information

NPI: 1740714294
Provider Name (Legal Business Name): RACHAEL LEE KOCH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL LEE MEISTE

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 HEPBURN ST
WILLIAMSPORT PA
17701-6122
US

IV. Provider business mailing address

3530 RIVER RD
WATSONTOWN PA
17777-8658
US

V. Phone/Fax

Practice location:
  • Phone: 570-567-5400
  • Fax: 877-551-9931
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP021946
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22135
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: