Provider Demographics
NPI:1831335173
Name:KOCH, KIMBERLY ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:KOCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 405
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6607
Mailing Address - Country:US
Mailing Address - Phone:817-595-4949
Mailing Address - Fax:817-595-4951
Practice Address - Street 1:1305 AIRPORT FWY STE 405
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6607
Practice Address - Country:US
Practice Address - Phone:817-595-4949
Practice Address - Fax:817-595-4951
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116472363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health