Provider Demographics
NPI:1457520777
Name:COCKRELL LM CPM, DAWN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:COCKRELL LM CPM
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 SCR 1309
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-9656
Mailing Address - Country:US
Mailing Address - Phone:432-563-3297
Mailing Address - Fax:
Practice Address - Street 1:3602 SCR 1309
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-9656
Practice Address - Country:US
Practice Address - Phone:432-563-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02030019174400000X
TX01010176B00000X
NM04001R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67382541Medicaid