Provider Demographics
NPI:1356733356
Name:KORAH, ROBBY JACOB (NP)
Entity type:Individual
Prefix:
First Name:ROBBY
Middle Name:JACOB
Last Name:KORAH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14960 PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5165
Mailing Address - Country:US
Mailing Address - Phone:281-298-1144
Mailing Address - Fax:281-298-1133
Practice Address - Street 1:23920 KATY FWY STE 150
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0881
Practice Address - Country:US
Practice Address - Phone:281-298-1144
Practice Address - Fax:281-298-1133
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127493363L00000X, 363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3812901-05Medicaid