Active NPI
Jackie Koekkoek, MSOM, L AC., LMBT
- Acupuncturist
- Leland, NC
National Provider Identifier
1265784938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 639
- Practice address
- 1105 New Pointe Blvd
Leland, NC 28451-4127 - Phone
- (303) 775-9908
- NPI assigned
- Oct 5, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 639 | NC | Primary |
Addresses
Primary practice location
1105 New Pointe Blvd
Leland, NC 28451-4127
Mailing address
141 Muscadine TRL
Wallace, NC 28466-2365
Phone (303) 775-9908
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 639 | NC | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349395200000",
"number": "1265784938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 MUSCADINE TRL",
"city": "WALLACE",
"state": "NC",
"postal_code": "284662365",
"telephone_number": "303-775-9908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 NEW POINTE BLVD",
"city": "LELAND",
"state": "NC",
"postal_code": "284514127",
"telephone_number": "303-775-9908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEKKOEK",
"first_name": "JACKIE",
"credential": "MSOM, L AC., LMBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-05",
"last_updated": "2012-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NC",
"license": "639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leland, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.