Provider Demographics
NPI:1124095740
Name:COCHRAN, TRESSA (FNP-C)
Entity type:Individual
Prefix:
First Name:TRESSA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:807 FARSON ST STE 203C
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1069
Practice Address - Country:US
Practice Address - Phone:740-423-9640
Practice Address - Fax:740-423-9648
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV48274363L00000X
OHAPRN.CNP.072976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7104174000Medicaid
OH2380892Medicaid
WV7104174000Medicaid
WV7104174000Medicaid
WVP79830Medicare UPIN
OH2380892Medicaid