Provider Demographics
NPI:1306590369
Name:COCHRAN GOODE, TIARA LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:LYNN
Last Name:COCHRAN GOODE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:LYNN
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0990
Mailing Address - Country:US
Mailing Address - Phone:859-239-2360
Mailing Address - Fax:
Practice Address - Street 1:511 MIDDLEBURG ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3009
Practice Address - Country:US
Practice Address - Phone:606-787-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant