# COCKE PHYSICIAN SERVICES, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215444500
- **Authorized official:** DERIK K KING (PRESIDENT)
- **Authorized official phone:** (423) 625-2200

## Contact information

- **Practice address:** 435 2ND ST, NEWPORT, TN 37821-3703
- **Practice address phone:** (423) 625-2200
- **Mailing address:** 200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
- **Mailing address phone:** (800) 893-9698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208M00000X | Hospitalist Physician | — | NULL | Yes |
| 208M00000X | Hospitalist Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/08/2018
- **Last updated:** 01/08/2018