Provider Demographics
NPI:1801263439
Name:NORMENT, COLBIE CROSS (PA)
Entity type:Individual
Prefix:
First Name:COLBIE
Middle Name:CROSS
Last Name:NORMENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8336
Mailing Address - Country:US
Mailing Address - Phone:903-939-7500
Mailing Address - Fax:903-939-7728
Practice Address - Street 1:305 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2327
Practice Address - Country:US
Practice Address - Phone:903-939-7500
Practice Address - Fax:903-939-7728
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-001OtherTRICARE
TX75-2616977-002OtherTRICARE
TX75-2616977-028OtherTRICARE
TX75-2616977-129OtherTRICARE
TX370095702Medicaid
TX623447YNSXOtherMEDICARE
TXP01967493OtherMEDICARE RAIL ROAD
TX75-0818167-022OtherTRICARE
TX8GM012OtherBCBS