Healthcare Provider Details

I. General information

NPI: 1225370745
Provider Name (Legal Business Name): EDYTA KOCZELA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4407
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 220
MORRISVILLE NC
27560-5490
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-7558
  • Fax: 919-934-7554
Mailing address:
  • Phone: 984-215-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5019151
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340896-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404166
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5019151
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306347-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: