Healthcare Provider Details

I. General information

NPI: 1487917324
Provider Name (Legal Business Name): GPK PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S 12TH ST STE 101
PFLUGERVILLE TX
78660-3960
US

IV. Provider business mailing address

103 S 12TH ST STE 101
PFLUGERVILLE TX
78660-3960
US

V. Phone/Fax

Practice location:
  • Phone: 512-989-3334
  • Fax: 512-989-3390
Mailing address:
  • Phone: 512-989-3334
  • Fax: 512-989-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number680265
License Number StateTX

VIII. Authorized Official

Name: MS. GUDRUN P COBB
Title or Position: OWNER
Credential: CPNP
Phone: 512-989-3334