Healthcare Provider Details

I. General information

NPI: 1215309380
Provider Name (Legal Business Name): CIERRA KOCHY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26506
US

IV. Provider business mailing address

207 EASTGATE DR
MORGANTOWN WV
26508-5940
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-1201
  • Fax:
Mailing address:
  • Phone: 304-290-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number78672
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: