Provider Demographics
NPI:1073093027
Name:COBLER, KAITLYN GRACE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:GRACE
Last Name:COBLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 SHEPPARD MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:VA
Mailing Address - Zip Code:24165-3512
Mailing Address - Country:US
Mailing Address - Phone:276-694-0220
Mailing Address - Fax:
Practice Address - Street 1:18877 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-5223
Practice Address - Country:US
Practice Address - Phone:276-694-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty