MEDICARE: MS. DARLENE CHRISTINE KOCICH FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	200881	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528170164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARLENE CHRISTINE KOCICH FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-0640
Country	:	US
Telephone Number	:	252-536-5440
Fax Number	:	252-536-5444

Provider Business Practice Location Address
First Line	:	108 MOSBY AVE
Second Line	:
City	:	LITTLETON
State	:	NC
Zip	:	27850-9411
Country	:	US
Telephone Number	:	252-586-5411
Fax Number	:	252-586-2028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/04/2012

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