Healthcare Provider Details

I. General information

NPI: 1740801190
Provider Name (Legal Business Name): AMBER LOUISE COBB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER BROWN

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 02/10/2022
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W STEEL ST
SEYMOUR MO
65746-8832
US

IV. Provider business mailing address

418 W STEEL ST
SEYMOUR MO
65746-8832
US

V. Phone/Fax

Practice location:
  • Phone: 417-935-2239
  • Fax:
Mailing address:
  • Phone: 417-935-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013034321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: