Healthcare Provider Details

I. General information

NPI: 1366235376
Provider Name (Legal Business Name): STEFANIE COKLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE KROUT

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 MAPLE LAWN BLVD
FULTON MD
20759-2681
US

IV. Provider business mailing address

1117 OAKWOOD LN
BEL AIR MD
21015-2519
US

V. Phone/Fax

Practice location:
  • Phone: 240-744-0001
  • Fax:
Mailing address:
  • Phone: 443-299-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR218771
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: