Healthcare Provider Details

I. General information

NPI: 1982408167
Provider Name (Legal Business Name): JORDAN COCHRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73015 HIGHWAY 25 STE A
COVINGTON LA
70435-5694
US

IV. Provider business mailing address

26315 PALE ALE CT
PONCHATOULA LA
70454-4263
US

V. Phone/Fax

Practice location:
  • Phone: 985-400-5370
  • Fax:
Mailing address:
  • Phone: 228-493-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200088
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: