MEDICARE: HOLLY MARIE COONEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	338882	NY
2	363LF0000X	Family Nurse Practitioner	0904017466	VA
3	363LF0000X	Family Nurse Practitioner	5021183	NC

General Provider Information

NPI Number	:	1285028522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY MARIE COONEY NP

Provider Business Mailing Address
First Line	:	905 THUNDER RD STE 140
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7672
Country	:	US
Telephone Number	:	252-334-0320
Fax Number	:	855-330-7320

Provider Business Practice Location Address
First Line	:	905 THUNDER RD STE 140
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7672
Country	:	US
Telephone Number	:	252-334-0320
Fax Number	:	855-330-7320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	12/19/2024

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