Healthcare Provider Details

I. General information

NPI: 1720910813
Provider Name (Legal Business Name): KATIE MICHELLE COCKRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MALVERN AVE
HOT SPRINGS AR
71901-7752
US

IV. Provider business mailing address

311 POLE THICKET RD
NORMAN AR
71960-8746
US

V. Phone/Fax

Practice location:
  • Phone: 501-321-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number237990
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR105870
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: