Provider Demographics
NPI:1679066070
Name:COBB, KENDELL NICOLE (MPA, PA-C)
Entity type:Individual
Prefix:
First Name:KENDELL
Middle Name:NICOLE
Last Name:COBB
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3804
Mailing Address - Country:US
Mailing Address - Phone:757-537-6418
Mailing Address - Fax:
Practice Address - Street 1:10004 SOUTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2705
Practice Address - Country:US
Practice Address - Phone:540-252-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant