Healthcare Provider Details

I. General information

NPI: 1215321559
Provider Name (Legal Business Name): MEAGAN EARLY COCKFIELD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 10/26/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PINEVIEW DR STE 101
KERNERSVILLE NC
27284
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-992-1351
  • Fax: 336-992-1361
Mailing address:
  • Phone: 336-992-1351
  • Fax: 336-992-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19260
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: