MEDICARE: ANA TATTERSALL-COCKE PMHNP-BC, CNS-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364S00000X	Clinical Nurse Specialist	AP109816	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10023633	OR
3	364SA2200X	Adult Health Clinical Nurse Specialist	AP109816	TX
4	363L00000X	Nurse Practitioner	AP109816	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	344932	OTHER	TX	AACC-ACNS-BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	153807605	OTHER	TX	CSHCN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699727214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA TATTERSALL-COCKE PMHNP-BC, CNS-BC

Provider Business Mailing Address
First Line	:	2355 STATE ST
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4541
Country	:	US
Telephone Number	:	503-391-0664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NE IRVING ST STE 210
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2243
Country	:	US
Telephone Number	:	971-365-3166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	01/27/2026

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Directions to “ ANA TATTERSALL-COCKE PMHNP-BC, CNS-BC” Practice Location

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