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NPI Code Detail

MEDICARE: MARANDA NAOMI KOCH

MEDICARE: MARANDA NAOMI KOCH
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
1363A00000XPhysician AssistantPT1430WY

General Provider Information

NPI Number : 1598571200
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARANDA NAOMI KOCH
Provider Business Mailing Address
First Line : PO BOX 3630
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86003-3630
Country : US
Telephone Number : 928-522-9879
Fax Number :
Provider Business Practice Location Address
First Line : 497 W LOTT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1658
Country : US
Telephone Number : 307-684-5521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2024
Last Update Date : 03/04/2026

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Directions to “ MARANDA NAOMI KOCH ” Practice Location

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