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General NPI Number Information
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NPI Number | 1538169131
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Entity Type | Individual
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Provider Name | CORAL L COUCHENOUR D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 104 E. MAIN STREET
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City | ANDERSON
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State | MO
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Zip | 64831-0750
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Country | US
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Telephone | 417-845-6984
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Fax | 417-845-6976
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Provider Business Mailing Address
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Address Line | PO BOX 750 104 E. MAIN STREET
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City | ANDERSON
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State | MO
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Zip | 64831-0750
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Country | US
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Telephone | 417-845-6984
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Fax | 417-845-6976
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2004017460
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License Number State | MO
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