Provider Demographics
NPI:1932332376
Name:COUSINS, VALERIE J (NP)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:J
Last Name:COUSINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6513
Mailing Address - Country:US
Mailing Address - Phone:910-792-1001
Mailing Address - Fax:910-792-1004
Practice Address - Street 1:5429 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6513
Practice Address - Country:US
Practice Address - Phone:910-792-1001
Practice Address - Fax:910-792-1001
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008429363L00000X, 363LF0000X
GARN204335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC303185172Medicaid