Provider Demographics
NPI:1437215258
Name:KOUBA, LINDA SUSAN (APN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:KOUBA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24275 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7267
Mailing Address - Country:US
Mailing Address - Phone:346-387-7171
Mailing Address - Fax:844-703-5305
Practice Address - Street 1:24275 KATY FWY STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7267
Practice Address - Country:US
Practice Address - Phone:346-387-7171
Practice Address - Fax:844-703-5305
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX432245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094087603Medicaid
TX8Y9247OtherBCBS PAR PLAN
TX094087603Medicaid