Provider Demographics
NPI:1235380627
Name:KOCI, NICOLE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:KOCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2665
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:724-438-8340
Practice Address - Street 1:204 MARY HIGGINSON LANE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2658
Practice Address - Country:US
Practice Address - Phone:724-438-8300
Practice Address - Fax:724-438-8340
Is Sole Proprietor?:No
Enumeration Date:2008-10-04
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053483363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA332314ZCTPMedicare PIN
PA137289V4CMedicare PIN