Jennifer Kathleen Cockley, RN
Individual provider Active NPI Registered Nurse · Archbold, OH
NPI 1174868053 · NPPES record last updated Dec 4, 2012
Key facts
- NPI
- 1174868053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN276929 (OH)
- Practice address
- 22961 Burlington Gardens St
Archbold, OH 43502-9314 - Phone
- (419) 559-9467
- NPI assigned
- Dec 4, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN276929 | OH | MD | Wound Care Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN276929 | OH | Yes |
| Home Health Registered Nurse | 163WH0200X | RN276929 | OH | |
| Wound Care Registered Nurse | 163WW0000X | RN276929 | OH |
Addresses
Primary practice location
22961 Burlington Gardens St
Archbold, OH 43502-9314
Mailing address
22961 Burlington Gardens St
Archbold, OH 43502-9314
Phone (419) 559-9467
Other providers in Archbold, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.