1962714196 NPI number — MRS. CHRISTINA ANN CAMP COCKERHAM WHNP

Table of content: MRS. CHRISTINA ANN CAMP COCKERHAM WHNP (NPI 1962714196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962714196 NPI number — MRS. CHRISTINA ANN CAMP COCKERHAM WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMP COCKERHAM
Provider First Name:
CHRISTINA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEACH
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962714196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 MAVERICK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANBURY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76049-1381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-731-8994
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E BERT KOUNS INDUSTRIAL LOOP STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-5647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-681-4606
Provider Business Practice Location Address Fax Number:
318-681-4607
Provider Enumeration Date:
07/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  AP06125 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2515331 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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