Provider Demographics
NPI:1093037731
Name:COCKRELL, MELISSA NORMA (NP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NORMA
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 COUNTY ROAD 575
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37329-5129
Mailing Address - Country:US
Mailing Address - Phone:907-512-7209
Mailing Address - Fax:
Practice Address - Street 1:1131 E INTERNATIONAL AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1408
Practice Address - Country:US
Practice Address - Phone:907-279-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURU1367363LF0000X
TNAPN0000014688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily