Provider Demographics
NPI:1396788519
Name:COCKRUM, HOLLY D (MD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:D
Last Name:COCKRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 SPRINGHILL DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2924
Mailing Address - Country:US
Mailing Address - Phone:501-835-9444
Mailing Address - Fax:501-835-9731
Practice Address - Street 1:3401 SPRINGHILL DR
Practice Address - Street 2:SUITE 390
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2924
Practice Address - Country:US
Practice Address - Phone:501-835-9444
Practice Address - Fax:501-835-9731
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M111Medicare PIN
AR5M111Medicare ID - Type Unspecified