Provider Demographics
NPI:1053721068
Name:COKER, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6533
Mailing Address - Country:US
Mailing Address - Phone:252-338-4044
Mailing Address - Fax:252-337-7928
Practice Address - Street 1:1417 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6533
Practice Address - Country:US
Practice Address - Phone:252-338-4044
Practice Address - Fax:252-337-7928
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
NC12153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist