Provider Demographics
NPI:1770797789
Name:KOTTYAN, VICTORIA LYNN (RD, PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:KOTTYAN
Suffix:
Gender:F
Credentials:RD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3420
Mailing Address - Country:US
Mailing Address - Phone:910-557-9447
Mailing Address - Fax:
Practice Address - Street 1:1000 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3420
Practice Address - Country:US
Practice Address - Phone:910-557-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002837133V00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered