Provider Demographics
NPI:1508844358
Name:DAVIS-COOLEY, DELINA JOSET (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DELINA
Middle Name:JOSET
Last Name:DAVIS-COOLEY
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 710
Mailing Address - Street 2:
Mailing Address - City:RICH SQUARE
Mailing Address - State:NC
Mailing Address - Zip Code:27869-0710
Mailing Address - Country:US
Mailing Address - Phone:252-539-2082
Mailing Address - Fax:252-539-2898
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICH SQUARE
Practice Address - State:NC
Practice Address - Zip Code:27869
Practice Address - Country:US
Practice Address - Phone:252-539-2028
Practice Address - Fax:252-539-2898
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101418363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2337628OtherUNITED HEALTH CARE #
NC84846OtherMEDCOST LLC PROVIDER #
NC2337628OtherUNITED HEALTH CARE #
NC84846OtherMEDCOST LLC PROVIDER #