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General NPI Number Information
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NPI Number | 1114743291
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Entity Type | Individual
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Provider Name | MACKENZIE KOCH DNP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2024
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 102 3RD AVE
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City | KEARNEY
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State | NE
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Zip | 68845-7820
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Country | US
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Telephone | 308-237-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 903 ARTHUR ST
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City | HOLDREGE
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State | NE
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Zip | 68949-1820
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Country | US
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Telephone | 308-991-5337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 115738
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License Number State | NE
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