Provider Demographics
NPI:1376584524
Name:COGGIN, SHARON DELOIS (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DELOIS
Last Name:COGGIN
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:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0484
Mailing Address - Country:US
Mailing Address - Phone:864-546-4497
Mailing Address - Fax:864-546-4506
Practice Address - Street 1:115 BRUSHY CREEK RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1120
Practice Address - Country:US
Practice Address - Phone:864-546-4497
Practice Address - Fax:864-546-4506
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101057363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1669897724Medicaid
NCNCG210COtherMEDICARE PTAN
SC0543PAMedicaid
NCNCG210DOtherMEDICARE PTAN
NCNCG210DOtherMEDICARE PTAN
NCR39794Medicare UPIN
NCNCG210D870Medicare PIN
NC1669897724Medicaid