Healthcare Provider Details

I. General information

NPI: 1093144719
Provider Name (Legal Business Name): NISHA KOTECHA F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 RIDGE VIEW DR STE A
CARY NC
27511-6647
US

IV. Provider business mailing address

910 CHANNING PARK CIR
CARY NC
27519-7636
US

V. Phone/Fax

Practice location:
  • Phone: 919-319-6363
  • Fax: 919-319-1331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number100121
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006590
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH0520002
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: