Provider Demographics
NPI:1841692241
Name:COCHRAN, KAYLA (FNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BARNWELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3937
Mailing Address - Country:US
Mailing Address - Phone:803-644-4403
Mailing Address - Fax:803-644-4405
Practice Address - Street 1:415 BARNWELL AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3937
Practice Address - Country:US
Practice Address - Phone:803-644-4403
Practice Address - Fax:803-644-4405
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN19029363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4185Medicaid
SC8296Medicare UPIN