Provider Demographics
NPI:1407577984
Name:COBB, MADISON GRAY (FNP)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:GRAY
Last Name:COBB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12082 NC 42
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9711
Mailing Address - Country:US
Mailing Address - Phone:919-906-2632
Mailing Address - Fax:
Practice Address - Street 1:1413 GREENWAY CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6954
Practice Address - Country:US
Practice Address - Phone:919-292-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily