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General NPI Number Information
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NPI Number | 1396708236
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Entity Type | Individual
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Provider Name | JANE C KOCH CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 2000 MON HEALTH MEDICAL PARK DR STE 2100
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City | MORGANTOWN
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State | WV
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Zip | 26505
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Country | US
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Telephone | 304-599-6811
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Fax | 304-599-7159
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Provider Business Mailing Address
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Address Line | 2000 MON HEALTH MEDICAL PARK DR STE 2100
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City | MORGANTOWN
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State | WV
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Zip | 26505-1134
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Country | US
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Telephone | 304-599-6811
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Fax | 304-599-7159
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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 | 30529
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License Number State | WV
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