Provider Demographics
NPI:1528149895
Name:COCHRAN, KELLEY D (PA-C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:D
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-9571
Mailing Address - Fax:606-408-6061
Practice Address - Street 1:607 S MAYO TRL STE B
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1250
Practice Address - Country:US
Practice Address - Phone:606-789-6464
Practice Address - Fax:606-789-6466
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA221363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100107730Medicaid
KY7100107730Medicaid