Individual
TRACEY KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
420 N SECOND AVE, SUITE 100, SANDPOINT, ID 83864-1565
(208) 265-2242
(208) 265-8214
Mailing address
420 N SECOND AVE, SUITE 100, SANDPOINT, ID 83864-1565
(208) 265-2242
(208) 265-8214
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NP461A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806191100
—
ID
Enumeration date
07/31/2006
Last updated
06/01/2012
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