Provider Demographics
NPI:1619953718
Name:KOCI, DAVIENNE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DAVIENNE
Middle Name:M
Last Name:KOCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAVIENNE
Other - Middle Name:M
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:909 SW MULVANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1677
Mailing Address - Country:US
Mailing Address - Phone:785-357-0301
Mailing Address - Fax:785-357-7581
Practice Address - Street 1:909 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1677
Practice Address - Country:US
Practice Address - Phone:785-357-0301
Practice Address - Fax:785-357-7581
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00941363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200004640BMedicaid
KS200004640AMedicaid
KS200004640AMedicaid
KSQ04998Medicare UPIN
KS200004640AMedicaid
KS068002056Medicare PIN