Provider Demographics
NPI:1699501791
Name:KOCHOSKY, AMANDA LOCKARD (AGACNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOCKARD
Last Name:KOCHOSKY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 QUAIL HUNT DR
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-6817
Mailing Address - Country:US
Mailing Address - Phone:704-746-8639
Mailing Address - Fax:
Practice Address - Street 1:1237 HARDING PLACE
Practice Address - Street 2:SUITE 4100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-355-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC262622363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care