Provider Demographics
NPI:1225023724
Name:COCHRAN, SONAL (PA)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 005 P O BOX 7587
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0587
Mailing Address - Country:US
Mailing Address - Phone:866-890-8895
Mailing Address - Fax:
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:SUITE 606
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-869-9877
Practice Address - Fax:502-896-9972
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500286100Medicaid
KY0394507Medicare ID - Type Unspecified
KYS68885Medicare UPIN