Provider Demographics
NPI:1073971909
Name:COCKRELL, TRISHA ANNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:ANNE
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3889 S JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1927
Mailing Address - Country:US
Mailing Address - Phone:660-233-2291
Mailing Address - Fax:
Practice Address - Street 1:3889 S JACKSON DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1927
Practice Address - Country:US
Practice Address - Phone:660-233-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-06
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner