MEDICARE: IRINA KOCHERSPERGER AGACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	28191485A	IN
2	363LA2100X	Acute Care Nurse Practitioner	28191485A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28191485A	OTHER	IN	STATE LICENSE

General Provider Information

NPI Number	:	1366918104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA KOCHERSPERGER AGACNP

Provider Business Mailing Address
First Line	:	5401 VOGEL RD STE 630
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-7835
Country	:	US
Telephone Number	:	812-483-7153
Fax Number	:	812-303-4500

Provider Business Practice Location Address
First Line	:	5401 VOGEL RD STE 630
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-7835
Country	:	US
Telephone Number	:	812-483-7153
Fax Number	:	812-303-4500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	11/03/2025

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