Provider Demographics
NPI:1649577982
Name:ROSS, JIMMIE COCHRAN (RN, DNP, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JIMMIE
Middle Name:COCHRAN
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 TOULINE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4639
Mailing Address - Country:US
Mailing Address - Phone:318-238-7083
Mailing Address - Fax:
Practice Address - Street 1:126 TOULINE ST.
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-238-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN039849 AP03788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2169441Medicaid