Healthcare Provider Details

I. General information

NPI: 1811716178
Provider Name (Legal Business Name): PEYTON K COKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ELLIS ST STE 1
VENUS TX
76084-3390
US

IV. Provider business mailing address

2400 ELLIS ST STE 1
VENUS TX
76084-3390
US

V. Phone/Fax

Practice location:
  • Phone: 682-877-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85003
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number22-245779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: