Healthcare Provider Details

I. General information

NPI: 1770085763
Provider Name (Legal Business Name): JONETTE COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 KANIS RD STE 2
LITTLE ROCK AR
72211-3794
US

IV. Provider business mailing address

11700 KANIS RD STE 2
LITTLE ROCK AR
72211-3794
US

V. Phone/Fax

Practice location:
  • Phone: 501-221-1941
  • Fax:
Mailing address:
  • Phone: 501-221-1941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR070135
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: