Provider Demographics
NPI:1982944922
Name:COBB, MELANIE R (PA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:COBB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:R
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8210 WALNUT HILL LN STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4418
Mailing Address - Country:US
Mailing Address - Phone:214-750-8504
Mailing Address - Fax:214-750-8504
Practice Address - Street 1:5900 ALTAMESA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-5473
Practice Address - Country:US
Practice Address - Phone:817-854-9969
Practice Address - Fax:817-854-9965
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327444101Medicaid
TX327444101Medicaid