Provider Demographics
NPI:1245990225
Name:COCHRAN, VICTORIA MICHELLE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MICHELLE
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 1:3 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-1209
Mailing Address - Country:US
Mailing Address - Phone:864-360-1699
Mailing Address - Fax:
Practice Address - Street 1:3 HARRIS ST
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-1209
Practice Address - Country:US
Practice Address - Phone:864-360-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily