| Doctor Name: | MRS. PHYLLIS PATRICIA COCONIS |
| NPI Number: | 1073815957 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 171157 |
| Business Practice Address: | 216 Moore Rd King, NC - 270218703 |
| Business Phone Number: | 3369834346 |
| Business Fax Number: | 3369855101 |
| Mailing Address: | Po Box 751803, CHARLOTTE |
| State: | NC |
| Postal Code: | 282751803 |
| Phone Number: | 3369834346 |
| Fax Number: | 3369855101 |
| NPI Enumeration Date: | 11/25/2010 |
| NPI Last Update Date: | 12/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 171157 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |