Healthcare Provider Details

I. General information

NPI: 1801955984
Provider Name (Legal Business Name): AMY ELIZABETH GILBERT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH KUCHINSKI FNP

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 300
RALEIGH NC
27607-7514
US

IV. Provider business mailing address

4414 LAKE BOONE TRL
RALEIGH NC
27607-7513
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-5510
  • Fax:
Mailing address:
  • Phone: 919-781-5510
  • Fax: 919-781-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number00502025
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number005002025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: