Provider Demographics
NPI:1376508358
Name:COCHRAN, KIMBERLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 W 75TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2205
Mailing Address - Country:US
Mailing Address - Phone:913-632-9810
Mailing Address - Fax:
Practice Address - Street 1:8800 W 75TH ST
Practice Address - Street 2:STE 100
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2205
Practice Address - Country:US
Practice Address - Phone:913-632-9810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04265092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG48780Medicare UPIN
KS479B616Medicare ID - Type Unspecified
MO479B616AMedicare ID - Type Unspecified