Individual
TANYA COCKRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1324 MILITARY RD, COLUMBUS, MS 39701-3616
(662) 630-5001
Mailing address
1324 MILITARY RD, COLUMBUS, MS 39701-3616
(662) 630-5001
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R874320
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R874320
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02928257
—
MS
Enumeration date
03/10/2014
Last updated
04/25/2025
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