Basic Information
| Provider Information | |||||||||
| NPI: | 1710979901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COCKSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 N KANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689014453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024637711 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 214 W 6TH ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | YORK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 684672903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023627430 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 01/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 855 | NE | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 82249 | 01 | NE | BLUE CROSS BLUE SHIELD NE | OTHER |