Provider Demographics
NPI:1710279872
Name:KOCH, ALISHA RENAE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:RENAE
Last Name:KOCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S CLARK AVE
Mailing Address - Street 2:P.O. BOX 828
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-3003
Mailing Address - Country:US
Mailing Address - Phone:620-257-7150
Mailing Address - Fax:
Practice Address - Street 1:619 S CLARK AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-3003
Practice Address - Country:US
Practice Address - Phone:620-257-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1496664061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily