Provider Demographics
NPI:1609586353
Name:KISLING, KOBE JARRETT
Entity Type:Individual
Prefix:
First Name:KOBE
Middle Name:JARRETT
Last Name:KISLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 DERBY RIDGE DR APT 410
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3492
Mailing Address - Country:US
Mailing Address - Phone:417-316-0052
Mailing Address - Fax:
Practice Address - Street 1:5000 DERBY RIDGE DR APT 410
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3492
Practice Address - Country:US
Practice Address - Phone:417-316-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program