Provider Demographics
NPI:1457179087
Name:COCHRAN, JESSICA MARIE (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12372 AZURE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2992
Mailing Address - Country:US
Mailing Address - Phone:703-939-0817
Mailing Address - Fax:
Practice Address - Street 1:12372 AZURE LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2992
Practice Address - Country:US
Practice Address - Phone:703-939-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant