Basic Information
| Provider Information | |||||||||
| NPI: | 1457904526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COBB | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2102 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024611612 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2501 KENTUCKY AVE | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705758472 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2019 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3013562 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.