Healthcare Provider Details

I. General information

NPI: 1437890787
Provider Name (Legal Business Name): KERRY FRANCIS COBB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 FOOTHILL BLVD
ROCK SPRINGS WY
82901-4756
US

IV. Provider business mailing address

2632 FOOTHILL BLVD
ROCK SPRINGS WY
82901-4756
US

V. Phone/Fax

Practice location:
  • Phone: 307-212-8014
  • Fax:
Mailing address:
  • Phone: 307-212-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPPC-1295
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: