Individual provider · Type 1 NPI

Kodi J. Puckett, PA

Medical Physician Assistant · Va Beach, VA

NPI number 1184004475 Active

Practice location

4092 Foxwood Dr, Ste 100
Va Beach, VA 23462-5225

Fax (757) 686-0541

Mailing address

PO Box 7549
Portsmouth, VA 23707-0549

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XNone listed

Medical Physician Assistant: Definition to come...

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About NPI 1184004475

Kodi J. Puckett, PA's National Provider Identifier is 1184004475, issued on Jun 2, 2015. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Va Beach, VA. The record was last updated on Sep 4, 2015.