Provider Demographics
NPI:1598038598
Name:COBB, KELLI THOMAS (NP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:THOMAS
Last Name:COBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELI
Other - Middle Name:MICHELLE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3304 WESTMILL DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-6119
Mailing Address - Country:US
Mailing Address - Phone:256-603-1133
Mailing Address - Fax:
Practice Address - Street 1:119 TRAILING VINE
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749
Practice Address - Country:US
Practice Address - Phone:256-603-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1085624363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health