Provider Demographics
NPI:1124381579
Name:COBB, KIM W (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:W
Last Name:COBB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 STANDARD REED CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9483
Mailing Address - Country:US
Mailing Address - Phone:318-396-4279
Mailing Address - Fax:
Practice Address - Street 1:1650 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7722
Practice Address - Country:US
Practice Address - Phone:318-361-7370
Practice Address - Fax:318-632-3421
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA078454163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health