Provider Demographics
NPI:1376113530
Name:COCHRAN, CHARISSA (NP)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 HEDGESVILLE RD STE H
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-6704
Mailing Address - Country:US
Mailing Address - Phone:304-754-7160
Mailing Address - Fax:
Practice Address - Street 1:3790 HEDGESVILLE RD STE H
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-6704
Practice Address - Country:US
Practice Address - Phone:304-754-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily