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General NPI Number Information
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NPI Number | 1366036451
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Entity Type | Individual
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Provider Name | AMY ELIZABETH KOCH FNP
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Gender | Female
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 111 W HIGH ST
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City | ROCKVILLE
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State | IN
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Zip | 47872-1735
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Country | US
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Telephone | 765-569-2057
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Fax | 765-569-2340
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Provider Business Mailing Address
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Address Line | 1606 N 7TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47804-2706
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Country | US
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Telephone | 812-238-4989
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Fax | 812-238-4508
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71010895A
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License Number State | IN
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