1720425630 NPI number — CHERYL LYNN HOBBS FNP-C

Table of content: CHERYL LYNN HOBBS FNP-C (NPI 1720425630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720425630 NPI number — CHERYL LYNN HOBBS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOBBS
Provider First Name:
CHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720425630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 SAINT MICHAEL DR STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-614-5367
Provider Business Mailing Address Fax Number:
903-614-5343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8445 MEMORIAL BLVD STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-982-6461
Provider Business Practice Location Address Fax Number:
409-938-7461
Provider Enumeration Date:
05/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP123679 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 318127708 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 348127709 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1K1840 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P02601540 . This is a "MCRR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1K1841 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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