Healthcare Provider Details

I. General information

NPI: 1528170164
Provider Name (Legal Business Name): DARLENE CHRISTINE KOCICH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MOSBY AVE
LITTLETON NC
27850-9411
US

IV. Provider business mailing address

PO BOX 640
ROANOKE RAPIDS NC
27870-0640
US

V. Phone/Fax

Practice location:
  • Phone: 252-586-5411
  • Fax: 252-586-2028
Mailing address:
  • Phone: 252-536-5440
  • Fax: 252-536-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: