Provider Demographics
NPI:1457305930
Name:FECIK, CONNIE M (FNP BC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:FECIK
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-847-3897
Mailing Address - Fax:252-847-3891
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-847-3897
Practice Address - Fax:252-847-3891
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133N5Medicaid
NC133N5OtherBLUE CROSS BLUE SHIELD
NCFH2001400OtherFIRST CAROLINA CARE
NC060040795OtherRAILROAD
SCN00176OtherSC MEDICAID
NCP70105Medicare UPIN
NC2012900Medicare ID - Type UnspecifiedMEDICARE