Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP05605 | LA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP05605 | LA |
NPI | 1003066606 |
---|---|
Provider Name | Yolanda Rochelle Cockerham |
First Address | Baton Rouge, LA 70896-6156 |
Second Address | Baton Rouge, LA 70806-3757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2008 |
Last Update Date | 21/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1355411 | (05) | LA |