Provider Demographics
NPI:1366459851
Name:COBOS, JUDY KAYE (NP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:KAYE
Last Name:COBOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DREAMWEAVER DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6581
Mailing Address - Country:US
Mailing Address - Phone:928-771-2140
Mailing Address - Fax:
Practice Address - Street 1:8485 E YAVAPAI RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-775-0669
Practice Address - Fax:928-759-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN455955363LP0200X
AZRN144099363LP0200X
CANP9692363LP0200X
AZAP 2637363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics