Healthcare Provider Details

I. General information

NPI: 1881836831
Provider Name (Legal Business Name): KIMBERLY COCHRAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST STE 400
SPRINGFIELD MO
65807-5179
US

IV. Provider business mailing address

1000 E PRIMROSE ST STE 400
SPRINGFIELD MO
65807-5179
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-7900
  • Fax:
Mailing address:
  • Phone: 417-269-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number106707
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: