Provider Demographics
NPI:1144209081
Name:COBB, AMY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:1007 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2714
Practice Address - Country:US
Practice Address - Phone:606-528-0305
Practice Address - Fax:606-523-4368
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004098363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK158120OtherMEDICARE PTAN
KYP01380422OtherRR MEDICARE
KY000000360920OtherANTHEM
KY78010626Medicaid
KY000000360920OtherANTHEM