Provider Demographics
NPI:1225136120
Name:KOKOSZKA, ANDRIA K (NP)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:K
Last Name:KOKOSZKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1900
Mailing Address - Fax:704-384-1919
Practice Address - Street 1:301 HAWTHORNE LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2450
Practice Address - Country:US
Practice Address - Phone:704-384-1900
Practice Address - Fax:704-384-1919
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005002307363L00000X
NC502307363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005290Medicaid
NC2592735Medicare PIN