Provider Demographics
NPI:1326191230
Name:COCHRAN, BETHANIE C (WHNP)
Entity type:Individual
Prefix:MRS
First Name:BETHANIE
Middle Name:C
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MRS
Other - First Name:BETHANIE
Other - Middle Name:C
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:12220 IRON BRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1543
Mailing Address - Country:US
Mailing Address - Phone:804-706-5827
Mailing Address - Fax:804-706-5819
Practice Address - Street 1:12220 IRON BRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1543
Practice Address - Country:US
Practice Address - Phone:804-706-5827
Practice Address - Fax:804-706-5819
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017138536363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975189Medicaid
VA1326191230Medicaid
VA600699119Medicare ID - Type Unspecified
VA022589J52Medicare PIN