Provider Demographics
NPI:1104570886
Name:COCHRAN, MELISSA KATHRYN (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHRYN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3899
Mailing Address - Country:US
Mailing Address - Phone:919-865-8710
Mailing Address - Fax:
Practice Address - Street 1:6026 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3899
Practice Address - Country:US
Practice Address - Phone:919-865-8710
Practice Address - Fax:919-977-9760
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC278708163W00000X
NC5017782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse