Provider Demographics
NPI:1487025771
Name:BOBBY, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BOBBY
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:PO BOX 17685
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-7685
Mailing Address - Country:US
Mailing Address - Phone:281-491-6767
Mailing Address - Fax:281-565-1102
Practice Address - Street 1:16605 SOUTHWEST FRWY
Practice Address - Street 2:SUITE 175
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-0003
Practice Address - Country:US
Practice Address - Phone:281-491-6767
Practice Address - Fax:281-565-1102
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8798NSOtherBCBS
TX353190701OtherMEDICAID
TX463495YKMPOtherMEDICARE
TX570574OtherUNITED HC
TX4819626OtherAETNA