Provider Demographics
NPI:1639120280
Name:COUCH, JUDITH DIANE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:DIANE
Last Name:COUCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 WITHROW RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9659
Mailing Address - Country:US
Mailing Address - Phone:513-726-1199
Mailing Address - Fax:
Practice Address - Street 1:8837 CHAPELSQUARE LN
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-4706
Practice Address - Country:US
Practice Address - Phone:513-229-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily