Healthcare Provider Details

I. General information

NPI: 1700645140
Provider Name (Legal Business Name): MCKINLEY BROOKE ISAACS-COCHRAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E MAIN ST
WISE VA
24293-5402
US

IV. Provider business mailing address

217 E MAIN ST
WISE VA
24293-5402
US

V. Phone/Fax

Practice location:
  • Phone: 276-298-5034
  • Fax: 276-213-3014
Mailing address:
  • Phone: 276-298-5034
  • Fax: 276-213-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36088
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number257386
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024190424
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: