Provider Demographics
NPI:1477753929
Name:COCKROFT, LINDA B (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:B
Last Name:COCKROFT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 23996
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3996
Mailing Address - Country:US
Mailing Address - Phone:601-206-6100
Mailing Address - Fax:601-206-6052
Practice Address - Street 1:530 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3858
Practice Address - Country:US
Practice Address - Phone:662-289-9155
Practice Address - Fax:662-289-2776
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR623954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05135821Medicaid
MS05135821Medicaid