Provider Demographics
NPI:1861725491
Name:COCHRAN, KELLIE ANNETTE (ANP)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANNETTE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:34 HEALTHPARK WAY STE 100C
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4497
Practice Address - Country:US
Practice Address - Phone:919-585-8850
Practice Address - Fax:919-585-8869
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004471363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5004471OtherNC STATE LICENSE #
NC173XPOtherBCBS OF NC
NC1861725491Medicaid
NCMC2027084OtherDEA NUMBER
NC1861725491Medicaid
NCNC3796CMedicare PIN
NCNC37960322Medicare PIN