Provider Demographics
NPI:1285164236
Name:COCHRANE, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:COCHRANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75TH MEDICAL GROUP
Mailing Address - Street 2:7321 BALMER STREET BUILDING 570
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75TH MEDICAL GROUP
Practice Address - Street 2:7321 BALMER STREET BUILDING 570
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056
Practice Address - Country:US
Practice Address - Phone:801-777-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT317986-3102163WE0003X
UT317986-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency