| NPI | 1528303039 |
|---|---|
| Former Name | TISHA LYNN COUCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 75755) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75755-022) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2021-12-03 |