Provider Demographics
NPI:1467251066
Name:COUCH, HOMER (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:HOMER
Middle Name:
Last Name:COUCH
Suffix:
Gender:
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:41348-0286
Mailing Address - Country:US
Mailing Address - Phone:606-309-5729
Mailing Address - Fax:
Practice Address - Street 1:638 E COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2363
Practice Address - Country:US
Practice Address - Phone:606-318-3500
Practice Address - Fax:606-318-3503
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4036163363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101052340Medicaid