Provider Demographics
NPI:1174868053
Name:COCKLEY, JENNIFER KATHLEEN (RN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:COCKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22961 BURLINGTON GARDENS ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-9314
Mailing Address - Country:US
Mailing Address - Phone:419-559-9467
Mailing Address - Fax:
Practice Address - Street 1:22961 BURLINGTON GARDENS ST
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-9314
Practice Address - Country:US
Practice Address - Phone:419-559-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN276929163W00000X, 163WH0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care