Provider Demographics
NPI:1154646917
Name:COBB, CAMILLE N (CPNP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:N
Last Name:COBB
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2733
Mailing Address - Country:US
Mailing Address - Phone:682-885-6163
Mailing Address - Fax:
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-3817
Practice Address - Fax:682-885-3825
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118445363LP0200X, 363LA2100X
TX588553363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280240704Medicaid
TX8HJ149OtherBCBSTX
TXPENDINGMedicaid
TXB124641Medicare PIN
TXB124641Medicare PIN