Basic Information
| Provider Information | |||||||||
| NPI: | 1356733356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORAH | ||||||||
| FirstName: | ROBBY | ||||||||
| MiddleName: | JACOB | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14960 PARK ROW DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770845165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812981144 | ||||||||
| FaxNumber: | 2812981133 | ||||||||
| Practice Location | |||||||||
| Address1: | 23920 KATY FWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774940881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812981144 | ||||||||
| FaxNumber: | 2812981133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2015 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP127493 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | AP127493 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | AP127493 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3812901-05 | 05 | TX | MEDICAID |