MEDICARE: KATHERINE ANNE COCKS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0600X	Gerontology Registered Nurse	R49667	OK
2	163WC1500X	Community Health Registered Nurse	R49667	OK

General Provider Information

NPI Number	:	1306695622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANNE COCKS RN

Provider Business Mailing Address
First Line	:	9828 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-4208
Country	:	US
Telephone Number	:	405-769-2551
Fax Number	:

Provider Business Practice Location Address
First Line	:	9828 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-4208
Country	:	US
Telephone Number	:	405-769-2551
Fax Number	:	405-769-6255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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