Provider Demographics
NPI:1255851267
Name:COCKRELL, KEISHA NICOLE
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:NICOLE
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 124TH ST APT 5M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2083
Mailing Address - Country:US
Mailing Address - Phone:646-455-0246
Mailing Address - Fax:
Practice Address - Street 1:245 E 124TH ST APT 5M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2083
Practice Address - Country:US
Practice Address - Phone:646-455-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator