Provider Demographics
NPI:1740615780
Name:COBB, HOLLY (APRN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 NW HUNTERS RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-2509
Mailing Address - Country:US
Mailing Address - Phone:785-246-3733
Mailing Address - Fax:785-246-3406
Practice Address - Street 1:3405 NW HUNTERS RIDGE TER
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2509
Practice Address - Country:US
Practice Address - Phone:785-246-3733
Practice Address - Fax:785-246-3406
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376050-121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily