Provider Demographics
NPI:1962541979
Name:KOKKINIS, CHERYL LANDRY (OTR)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LANDRY
Last Name:KOKKINIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 KELLER PKWY
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3614
Mailing Address - Country:US
Mailing Address - Phone:817-562-3111
Mailing Address - Fax:817-562-3114
Practice Address - Street 1:1101 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3614
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:817-562-3114
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1922OtherBCBS PROVIDER NUMBER