Healthcare Provider Details

I. General information

NPI: 1447804463
Provider Name (Legal Business Name): CHELSEA LEIGH COCKRELL AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST STE 2A
JACKSON MS
39202-2413
US

IV. Provider business mailing address

778 LIBERTY RD
FLOWOOD MS
39232-9300
US

V. Phone/Fax

Practice location:
  • Phone: 769-243-6141
  • Fax:
Mailing address:
  • Phone: 769-239-3793
  • Fax: 601-477-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903356
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD33077
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: