Provider Demographics
NPI:1730889577
Name:KOCH, ANNA JO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:JO
Last Name:KOCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-8354
Mailing Address - Country:US
Mailing Address - Phone:919-279-7065
Mailing Address - Fax:
Practice Address - Street 1:803 TILGHMAN DR STE 100
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6699
Practice Address - Country:US
Practice Address - Phone:910-892-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty