Provider Demographics
NPI:1609959246
Name:KOEHN, AMY R (NNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:KOEHN
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:RUNFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3594 SW 208TH ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64477-9332
Mailing Address - Country:US
Mailing Address - Phone:317-965-8924
Mailing Address - Fax:
Practice Address - Street 1:3594 SW 208TH ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-9332
Practice Address - Country:US
Practice Address - Phone:317-965-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023049467363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200543030Medicaid