Provider Demographics
NPI:1942600887
Name:COCHRUN, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:COCHRUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 ROYAL OAKS DR
Mailing Address - Street 2:NONE
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4045
Mailing Address - Country:US
Mailing Address - Phone:937-878-4003
Mailing Address - Fax:
Practice Address - Street 1:267 ROYAL OAKS DR
Practice Address - Street 2:NONE
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4045
Practice Address - Country:US
Practice Address - Phone:937-878-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide