Active NPI
Keith Cockle
- Peer Specialist
- Grove, OK
National Provider Identifier
1376908962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 129951
- Practice address
- 1115 Harbor Rd
Grove, OK 74344-3505 - Phone
- (918) 786-4434
- Fax
- (918) 786-4435
- NPI assigned
- Dec 23, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 129951 | OK | Primary |
Addresses
Primary practice location
1115 Harbor Rd
Grove, OK 74344-3505
Mailing address
1115 Harbor Rd
Grove, OK 74344-3505
Phone (918) 786-4434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 129951 | OK | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491782400000",
"number": "1376908962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 HARBOR RD",
"city": "GROVE",
"state": "OK",
"postal_code": "743443505",
"telephone_number": "918-786-4434",
"fax_number": "918-786-4435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 HARBOR RD",
"city": "GROVE",
"state": "OK",
"postal_code": "743443505",
"telephone_number": "918-786-4434",
"fax_number": "918-786-4435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COCKLE",
"first_name": "KEITH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-12-23",
"last_updated": "2017-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OK",
"license": "129951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grove, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.