Basic Information
| Provider Information | |||||||||
| NPI: | 1982132973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOCH | ||||||||
| FirstName: | HAYLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 10TH ST | ||||||||
| Address2: | SUITE 715 | ||||||||
| City: | ASPINWALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152151605 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 256 NEW CASTLE RD | ||||||||
| Address2: | SUITE 715 | ||||||||
| City: | BUTLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160012576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242833627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2017 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA059215 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.