Provider Demographics
NPI:1134132111
Name:COOLEY OBRIEN, KRISTY L (PAC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:COOLEY OBRIEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2802 GARTH ROAD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-425-9313
Mailing Address - Fax:281-425-9524
Practice Address - Street 1:2802 GARTH ROAD
Practice Address - Street 2:SUITE 309
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-425-9313
Practice Address - Fax:281-425-9524
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant