Provider Demographics
NPI:1144912932
Name:SKAINS, CODY (RN)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:SKAINS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 E US HIGHWAY 80 STE 100
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8675
Mailing Address - Country:US
Mailing Address - Phone:972-564-0711
Mailing Address - Fax:
Practice Address - Street 1:763 E US HIGHWAY 80 STE 100
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8675
Practice Address - Country:US
Practice Address - Phone:972-564-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205873163W00000X
TX1125554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse