Provider Demographics
NPI:1194869636
Name:COLE, BARBARA JEAN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 GILLETTE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1207
Mailing Address - Country:US
Mailing Address - Phone:214-391-8097
Mailing Address - Fax:
Practice Address - Street 1:1364 GILLETTE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217
Practice Address - Country:US
Practice Address - Phone:214-391-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148618310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012285OtherCBA
TX001012024OtherCCAD