Provider Demographics
NPI:1871092478
Name:COCHRAN, KATHRYN GRACE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:GRACE
Other - Last Name:DOUGLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10449 N PALISADES WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9505
Mailing Address - Country:US
Mailing Address - Phone:865-964-9515
Mailing Address - Fax:
Practice Address - Street 1:201 CALIFORNIA ST STE 1300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5015
Practice Address - Country:US
Practice Address - Phone:844-847-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN195489163W00000X
TN23856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse