Active NPI
Reva Gwenette Coby
- Case Manager/Care Coordinator
- Oklahoma City, OK
National Provider Identifier
1417250143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 20684
- Practice address
- 2425 NE 10TH St
Oklahoma City, OK 73117-5007 - Phone
- (405) 424-2547
- Fax
- (405) 427-2662
- NPI assigned
- Dec 20, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 20684 | OK | Primary |
Addresses
Primary practice location
2425 NE 10TH St
Oklahoma City, OK 73117-5007
Mailing address
2425 NE 10TH St
Oklahoma City, OK 73117-5007
Phone (405) 424-2547
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100729210 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20684 | OK | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292803200000",
"number": "1417250143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2425 NE 10TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731175007",
"telephone_number": "405-424-2547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 NE 10TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731175007",
"telephone_number": "405-424-2547",
"fax_number": "405-427-2662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBY",
"first_name": "REVA",
"middle_name": "GWENETTE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-20",
"last_updated": "2010-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OK",
"license": "20684",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100729210",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.