Jamie Koller

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A13569 Issued in NC

Practice address

400 S Water St
Elizabeth City, NC 27909-4942

Phone

(252) 333-4569

NPI assigned

Jan 26, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1083112809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 SEAVIEW DR",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279329269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S WATER ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279094942",
            "telephone_number": "252-333-4569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "JAMIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-26",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A13569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Christian King, D.P.M.
• Paul Andrew Kizen, MD
• David Wesley Kleinschuster, PSY. D, M.ED, M.A.
• Holly Demarest Kockler, RN, FNP-BC
• Jenna Nicole Kockott
• Vincent J Kopp, MD
• Jennifer Ashley Kramer, M.S. CCC-SLP
• Alexandra W Kroeff, PA
• James Edward Kronlage, LCSW, ACSW, DCSW
• Stacy Kucharczk, CPNP

• Mental Health Counselor in Elizabeth City, NC
• Providers in Elizabeth City, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.