Provider Demographics
NPI:1285264390
Name:HEATHCOCK, ROCHELLE (APRN FNP-C)
Entity type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:
Last Name:HEATHCOCK
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SUNCREST TOWN CENTRE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1873
Mailing Address - Country:US
Mailing Address - Phone:304-598-2200
Mailing Address - Fax:304-599-2674
Practice Address - Street 1:600 SUNCREST TOWN CENTRE DR STE 310
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1873
Practice Address - Country:US
Practice Address - Phone:304-598-2200
Practice Address - Fax:304-599-2674
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily