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General NPI Number Information
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NPI Number | 1821676669
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Entity Type | Individual
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Provider Name | ANTHONY KOCH PMHNP
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Gender | Male
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 182 SW ACADEMY ST
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City | DALLAS
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State | OR
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Zip | 97338-1996
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Country | US
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Telephone | 503-623-9289
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Fax | 503-623-2731
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Provider Business Mailing Address
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Address Line | 6923 GIBSON RD
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City | CANFIELD
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State | OH
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Zip | 44406-8653
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Country | US
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Telephone | 330-398-1132
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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 | AP61289252
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0029697
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10009669
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN61287688
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NPF95024532
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.445266
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License Number State | OH
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