NPIMap

Individual provider Active NPI

Domonique Nikki Cochran, FNP

  • Family Nurse Practitioner
  • Hurley, MS
National Provider Identifier
1861761348
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R854690 Issued in MS
Practice address
7001 Hwy 614
Hurley, MS 39555
Phone
(228) 588-2938
Fax
(228) 588-9399
NPI assigned
Dec 29, 2011
Last updated
May 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R854690 MS Primary

Addresses

Primary practice location

7001 Hwy 614
Hurley, MS 39555

Mailing address

PO Box 850
Hurley, MS 39555-0850
Phone (228) 588-2938

Other identifiers 1

IdentifierTypeStateIssuer
09336715MedicaidMS

Other names 1

  • Domonique Havard Cochran Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dcochran11611@direct.mysrhs.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120125000741 MS Practitioner - Nurse Practitioner 6305013756 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Exceed Physical Therapy, LLCGroup PAC ID 8123378338, 72 clinicians
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

12261 Hwy 49
Suite 1
Gulfport, MS 39503-2976
Phone (228) 265-7185

7001 Hwy 614
Coastal Ambulatory Services
Hurley, MS 39555-5340
Phone (228) 588-6622

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Gulfport CurrentSince Jan 14, 2022 Accepting new patients
Singing River Health System CurrentSince Apr 6, 2013 Accepting new patients
Singing River Gulfport CurrentSince Jan 14, 2022 Accepting new patients
Inpatient Physician Services Past Accepting new patients

Locations

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1861761348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "HURLEY",
            "state": "MS",
            "postal_code": "395550850",
            "telephone_number": "228-588-2938",
            "fax_number": "228-588-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7001 HWY 614",
            "city": "HURLEY",
            "state": "MS",
            "postal_code": "39555",
            "telephone_number": "228-588-2938",
            "fax_number": "228-588-9399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COCHRAN",
        "first_name": "DOMONIQUE",
        "middle_name": "NIKKI",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-29",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R854690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09336715",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dcochran11611@direct.mysrhs.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "7001 Hwy 614",
            "city": "Hurley",
            "state": "MS",
            "country_code": "US",
            "postal_code": "39555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DOMONIQUE",
            "last_name": "COCHRAN",
            "middle_name": "HAVARD",
            "credential": "FNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Hurley, MS

Sources for this page

Verify at the official NPI Registry.