Provider Demographics
NPI:1740714294
Name:KOCH, RACHAEL LEE (CRNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEE
Last Name:KOCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LEE
Other - Last Name:MEISTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:246 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-1614
Practice Address - Country:US
Practice Address - Phone:570-584-5144
Practice Address - Fax:570-584-5416
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22135363LF0000X
PASP021946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily