Provider Demographics
NPI:1568152411
Name:COUCH, CALEB JOSIAH (PA)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:JOSIAH
Last Name:COUCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10744 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-7541
Mailing Address - Country:US
Mailing Address - Phone:620-205-8812
Mailing Address - Fax:
Practice Address - Street 1:10744 EDWARDS RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-7541
Practice Address - Country:US
Practice Address - Phone:620-205-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant