Provider Demographics
NPI:1619100765
Name:COUCH, HERBERT A (DNP, APRN, NP-C)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:A
Last Name:COUCH
Suffix:
Gender:M
Credentials:DNP, APRN, NP-C
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:ANTHONY
Other - Last Name:COUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, APRN, NP-C
Mailing Address - Street 1:638 E COLLEGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-2363
Mailing Address - Country:US
Mailing Address - Phone:606-318-3500
Mailing Address - Fax:606-318-3503
Practice Address - Street 1:638 E COLLEGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2363
Practice Address - Country:US
Practice Address - Phone:606-318-3500
Practice Address - Fax:606-318-3503
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006089363LF0000X
KY30006089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner