Provider Demographics
NPI:1811483480
Name:COCHRAN, KIMBERLY ANN (PHD MSN APRN PMHNP)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PHD MSN APRN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8194 W DEER VALLEY RD STE 106-516
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2127
Mailing Address - Country:US
Mailing Address - Phone:623-777-7551
Mailing Address - Fax:
Practice Address - Street 1:101 W 5TH ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-0400
Practice Address - Country:US
Practice Address - Phone:623-777-7551
Practice Address - Fax:623-666-6612
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61046297363LP0808X
NM59345363LP0808X
OH024140363LP0808X
NY403423363LP0808X
AZ223084363LP0808X
FLAPRN11014805363LP0808X
COC-RXN.0002327-C-NP363LP0808X
FL11014805363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2156425Medicaid
AZ993686Medicaid
NY06543815Medicaid