Provider Demographics
NPI:1003851437
Name:KUNKLE, ANDRA GODSOE (MD)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:GODSOE
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDRA
Other - Middle Name:BETH
Other - Last Name:GODSOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5965
Mailing Address - Fax:828-757-5104
Practice Address - Street 1:906 COLLEGE AVE SW
Practice Address - Street 2:SUITE C
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5428
Practice Address - Country:US
Practice Address - Phone:828-757-5509
Practice Address - Fax:828-757-5538
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5044KOtherBCBS
NC895044KMedicaid
NCF43107Medicare UPIN