Healthcare Provider Details

I. General information

NPI: 1447431424
Provider Name (Legal Business Name): DEBRA KOSKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TILGHMAN DR STE A
DUNN NC
28334-4958
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-892-6500
  • Fax: 910-302-5897
Mailing address:
  • Phone: 910-267-2042
  • Fax: 855-996-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201841
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: