Provider Demographics
NPI:1427454206
Name:KOECHERT, KRISTEN G (FNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:G
Last Name:KOECHERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1354
Practice Address - Country:US
Practice Address - Phone:610-998-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0029129163W00000X
VA0024189890363LF0000X
DELG-0000804363LF0000X
MI4704413109363LF0000X
MDR219611363LF0000X
WV119184363LF0000X
PASP015204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1427454206Medicaid
DE1427454206Medicaid
DE382228ZBZRMedicare PIN