Provider Demographics
NPI:1639603657
Name:COSBY, ELADIA (NP)
Entity type:Individual
Prefix:
First Name:ELADIA
Middle Name:
Last Name:COSBY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8292
Mailing Address - Country:US
Mailing Address - Phone:575-259-3537
Mailing Address - Fax:575-652-3431
Practice Address - Street 1:3865 E LOHMAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8292
Practice Address - Country:US
Practice Address - Phone:575-259-3537
Practice Address - Fax:575-652-3431
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133551363LA2100X, 363LP0808X
NM64548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care