Provider Demographics
NPI:1578250262
Name:COCHRAN, MADISON PAIGE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:PAIGE
Last Name:COCHRAN
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 1:403 GIBSON LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2577
Mailing Address - Country:US
Mailing Address - Phone:859-661-4529
Mailing Address - Fax:
Practice Address - Street 1:403 GIBSON LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2577
Practice Address - Country:US
Practice Address - Phone:859-661-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid