Provider Demographics
NPI:1124332770
Name:KOOSHKI, ADELEH NA (ANP)
Entity type:Individual
Prefix:MISS
First Name:ADELEH
Middle Name:NA
Last Name:KOOSHKI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10130 PERIMETER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0197
Mailing Address - Country:US
Mailing Address - Phone:888-849-7379
Mailing Address - Fax:855-857-7333
Practice Address - Street 1:610 N FAYETTEVILLE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-633-4020
Practice Address - Fax:336-633-4069
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004911363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health