Provider Demographics
NPI:1699008391
Name:KIMBERLY COBB APRN PLLC
Entity Type:Organization
Organization Name:KIMBERLY COBB APRN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:479-462-8043
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0582
Mailing Address - Country:US
Mailing Address - Phone:479-462-8043
Mailing Address - Fax:918-649-0067
Practice Address - Street 1:210 W ROBERT ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953
Practice Address - Country:US
Practice Address - Phone:918-649-0069
Practice Address - Fax:918-649-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-12
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty