Provider Demographics
NPI:1215554662
Name:COCKRELL, EMILY KATHYRN (APRN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHYRN
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2376
Mailing Address - Country:US
Mailing Address - Phone:405-562-0416
Mailing Address - Fax:
Practice Address - Street 1:133 KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2376
Practice Address - Country:US
Practice Address - Phone:405-562-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily