Provider Demographics
NPI:1447804463
Name:COCKRELL, CHELSEA LEIGH (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:LEIGH
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-477-3550
Mailing Address - Fax:601-477-2236
Practice Address - Street 1:1203 AVE B STE 200
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2080
Practice Address - Country:US
Practice Address - Phone:601-477-3550
Practice Address - Fax:601-477-2236
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD33077207LC0200X
MS903356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine