Provider Demographics
NPI:1376106518
Name:COTTON, JUDA ROCHELL
Entity Type:Individual
Prefix:
First Name:JUDA
Middle Name:ROCHELL
Last Name:COTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 N JOSEY LN STE 246
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2509
Mailing Address - Country:US
Mailing Address - Phone:469-630-5824
Mailing Address - Fax:
Practice Address - Street 1:3740 N JOSEY LN STE 246
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2509
Practice Address - Country:US
Practice Address - Phone:469-630-5824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA001036487251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care