Provider Demographics
NPI:1306546742
Name:COCKRELL, PHOEBE RENEE
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:RENEE
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 TABERNACLE RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9201
Mailing Address - Country:US
Mailing Address - Phone:740-649-6684
Mailing Address - Fax:
Practice Address - Street 1:79 TABERNACLE RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9201
Practice Address - Country:US
Practice Address - Phone:740-649-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide