Provider Demographics
NPI:1902390313
Name:KOBE, ALICIA M (NP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:KOBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 BRAMBLE TRCE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3461
Mailing Address - Country:US
Mailing Address - Phone:219-331-9042
Mailing Address - Fax:
Practice Address - Street 1:1451 MORTHLAND DR STE D
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6262
Practice Address - Country:US
Practice Address - Phone:219-663-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28202440A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner