KEITH COCKLE (NPI# 1376908962) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376908962 |
| Entity Type | Individual |
| Full Name | KEITH COCKLE |
| Practice Address |
1115 Harbor Rd Grove OK 74344-3505 |
| Practice Telephone | 9187864434 |
| Practice Fax Number | 9187864435 |
| Mailing Telephone | 9187864434 |
| Mailing Fax Number | 9187864435 |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2017-04-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 129951 | OK | Other Service Providers |
| Street Address |
1115 HARBOR RD |
| City | GROVE |
| State | OK |
| Zip Code | 74344-3505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063429181 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 1115 Harbor Rd, Grove, OK 74344-3505 | 2006-08-02 |
| 1669084620 | Deanna M Duvall | Social Worker | 1115 Harbor Rd, Grove, OK 74344-3505 | 2020-08-20 |
| 1558979831 | Amber Rae Coker | Case Manager/Care Coordinator | 1115 Harbor Rd, Grove, OK 74344-3505 | 2020-07-22 |
| 1275157166 | Katharine Jean Downing | Case Manager/Care Coordinator | 1115 Harbor Rd, Grove, OK 74344-3505 | 2020-06-05 |
| 1205464997 | Kristen Bartz | Case Manager/Care Coordinator | 1115 Harbor Rd, Grove, OK 74344-3505 | 2020-03-30 |
| 1144853631 | Jennifer Elizabeth Bowerman | Peer Specialist | 1115 Harbor Rd, Grove, OK 74344-3505 | 2020-02-13 |
| 1427697747 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 1115 Harbor Rd, Grove, OK 74344-3505 | 2020-01-03 |
| 1598302572 | Shelbi Ann Brock | Case Manager/Care Coordinator | 1115 Harbor Rd, Grove, OK 74344-3505 | 2019-12-09 |
| 1447896907 | Jennifer Lynne Andrews | Registered Nurse | 1115 Harbor Rd, Grove, OK 74344-3505 | 2019-11-20 |
| 1497399331 | Steven Graham Shackelford | Case Manager/Care Coordinator | 1115 Harbor Rd, Grove, OK 74344-3505 | 2019-11-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326604935 | Deborah Stauss | Massage Therapist | 2086 S Main St, Grove, OK 74344 | 2019-05-20 |
| 1841776705 | Progressive Orthotic & Prosthetic Services, Inc | Prosthetic/Orthotic Supplier | 10 E 6th St., Grove, OK 74344 | 2018-07-13 |
| 1205329232 | Andra Renee Mitchell | Speech-Language Pathologist | 825 E Third Street, Grove, OK 74344 | 2018-06-13 |
| 1861996217 | Jenniffer Colleen Clark I | Case Manager/Care Coordinator | 1115 Har-ber Rd, Grove, OK 74344 | 2018-03-21 |
| 1417458167 | Jason S Beckham | Case Manager/Care Coordinator | 32600 S. 625 Road, Grove, OK 74344 | 2018-02-27 |
| 1659872034 | Keli Elaine Whitlock | Peer Specialist | 5602 Us Hwy 59, Grove, OK 74344 | 2018-02-22 |
| 1851899454 | Nichole Marie Wooton | Case Manager/Care Coordinator | 1115 Har-ber Road, Grove, OK 74344 | 2018-01-29 |
| 1043766645 | Samantha Lane | Speech-Language Pathologist | 1046 Hillside Road, Grove, OK 74344 | 2016-09-01 |
| 1376927509 | Matthew Kyle Allen | Physical Therapy Assistant | 4621 Hwy 59 N, Grove, OK 74344 | 2015-07-17 |
| 1477807428 | Andrew Scott Littlejohn | Physical Therapy Assistant | 103 Harber Road, Grove, OK 74344 | 2012-10-30 |
| Find all providers in zip 74344 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144854654 | William A Richards IIi | Peer Specialist | 201 Anchor Ln, Grove, OK 74344-5401 | 2020-02-24 |
| 1477193928 | Brandon Yeager | Peer Specialist | 61024 E 246 Rd, Grove, OK 74344-0153 | 2020-01-13 |
| 1437629235 | Elizabeth Scott | Peer Specialist | 60405 E 252 Ln, Grove, OK 74344-7786 | 2018-12-05 |
| 1356826861 | Angela Littlejohn | Peer Specialist | 1115 S Harbor Rd, Grove, OK 74344-7918 | 2018-10-01 |
| 1760966071 | William Sievert | Peer Specialist | 425 Chopper Ct, Grove, OK 74344-3351 | 2018-09-21 |
| 1407350580 | Heath Adam Smith | Peer Specialist | 4602 Us Highway 59, Grove, OK 74344-4229 | 2018-03-22 |
| 1659872034 | Keli Elaine Whitlock | Peer Specialist | 5602 Us Hwy 59, Grove, OK 74344 | 2018-02-22 |
| 1144853631 | Jennifer Elizabeth Bowerman | Peer Specialist | 1115 Harbor Rd, Grove, OK 74344-3505 | 2020-02-13 |
| 1174182232 | Jeffery Alan Forbes | Peer Specialist | 32300 S 625 Rd, Grove, OK 74344-6285 | 2019-06-11 |
| 1477022044 | Lundi Brook Brickey | Peer Specialist | 1115 S. Harber Road, Grove, OK 74344-7918 | 2018-11-13 |
| Find all providers in GROVE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.