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General NPI Number Information
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NPI Number | 1598571200
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Entity Type | Individual
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Provider Name | MARANDA NAOMI KOCH
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 126 E MAIN ST STE B
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City | PAYSON
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State | AZ
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Zip | 85541-5488
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Country | US
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Telephone | 928-468-8610
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Fax | 928-468-8605
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Provider Business Mailing Address
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Address Line | PO BOX 3630
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City | FLAGSTAFF
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State | AZ
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Zip | 86003-3630
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Country | US
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Telephone | 928-522-9879
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11323
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License Number State | AZ
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