Healthcare Provider Details

I. General information

NPI: 1063718633
Provider Name (Legal Business Name): ERANESHA L COCHRAN PA-C, MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

169 KENTUCKY CIR
JACKSONVILLE AR
72076-1027
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3932
  • Fax:
Mailing address:
  • Phone: 832-289-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-705
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1121
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: