Provider Demographics
NPI:1245322981
Name:KOCKLER, HOLLY DEMAREST (RN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:DEMAREST
Last Name:KOCKLER
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 N. ROAD ST., STE K
Mailing Address - Street 2:CAROLINA COASTAL PLASTIC SURGERY
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-335-2293
Mailing Address - Fax:252-331-2387
Practice Address - Street 1:1141 N. ROAD ST., STE K
Practice Address - Street 2:CAROLINA COASTAL PLASTIC SURGERY
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-2293
Practice Address - Fax:252-331-2387
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC082463163WC1500X
NC200736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200736OtherNCBOM NP PRACTICE NUMBER
NC082463OtherRN LICENSE NUMBER
NCZF0000131Medicaid