Provider Demographics
NPI:1053131334
Name:COCHRAN-TINNEY, KASANDRA DAWN (LPN)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:DAWN
Last Name:COCHRAN-TINNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KASANDRA
Other - Middle Name:DAWN
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3436 MARY ELDER RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5050
Mailing Address - Country:US
Mailing Address - Phone:360-528-2590
Mailing Address - Fax:
Practice Address - Street 1:3436 MARY ELDER RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5050
Practice Address - Country:US
Practice Address - Phone:360-528-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61592666164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse