Provider Demographics
NPI:1073297727
Name:COUCH, AMY JO (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:COUCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SHOALEY BRANCH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-8486
Mailing Address - Country:US
Mailing Address - Phone:336-469-0013
Mailing Address - Fax:
Practice Address - Street 1:1255 CREEKSHIRE WAY STE 270
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3061
Practice Address - Country:US
Practice Address - Phone:833-701-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018243363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health