Healthcare Provider Details

I. General information

NPI: 1760173991
Provider Name (Legal Business Name): HOSEA KIBET KOECH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W EVANS ST
FLORENCE SC
29501-3441
US

IV. Provider business mailing address

2804 KINLOCH CT APT L
FLORENCE SC
29501-2025
US

V. Phone/Fax

Practice location:
  • Phone: 839-313-9540
  • Fax: 843-407-1067
Mailing address:
  • Phone: 803-269-9352
  • Fax: 843-407-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number27355
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27355
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: