Provider Demographics
NPI:1710409123
Name:COBB, LORA (NP)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 LANWARD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2845
Mailing Address - Country:US
Mailing Address - Phone:214-417-7690
Mailing Address - Fax:
Practice Address - Street 1:2700 TIBBETS DR STE 406
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6900
Practice Address - Country:US
Practice Address - Phone:817-576-6665
Practice Address - Fax:817-576-6663
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily