1245322981 NPI number — MS. HOLLY DEMAREST KOCKLER RN, FNP-BC

Table of content: MS. HOLLY DEMAREST KOCKLER RN, FNP-BC (NPI 1245322981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245322981 NPI number — MS. HOLLY DEMAREST KOCKLER RN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCKLER
Provider First Name:
HOLLY
Provider Middle Name:
DEMAREST
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245322981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 N. ROAD ST., STE K
Provider Second Line Business Mailing Address:
CAROLINA COASTAL PLASTIC SURGERY
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-335-2293
Provider Business Mailing Address Fax Number:
252-331-2387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 N. ROAD ST., STE K
Provider Second Line Business Practice Location Address:
CAROLINA COASTAL PLASTIC SURGERY
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-2293
Provider Business Practice Location Address Fax Number:
252-331-2387
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  082463 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 200736 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200736 . This is a "NCBOM NP PRACTICE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 082463 . This is a "RN LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: ZF0000131 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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