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General NPI Number Information
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NPI Number | 1467251066
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Entity Type | Individual
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Provider Name | HOMER COUCH APRN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 638 E COLLEGE AVE STE B
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City | STANTON
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State | KY
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Zip | 40380-2363
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Country | US
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Telephone | 606-318-3500
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Fax | 606-318-3503
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Provider Business Mailing Address
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Address Line | PO BOX 286
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City | LOST CREEK
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State | KY
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Zip | 41348-0286
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Country | US
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Telephone | 606-309-5729
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4036163
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License Number State | KY
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