Provider Demographics
NPI:1336352327
Name:COBB, KRISTI LYNN (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:COBB
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LYNN
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-7013
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:170 CURTIS PKWY NE STE 1
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2062
Practice Address - Country:US
Practice Address - Phone:706-879-5770
Practice Address - Fax:706-624-4336
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137113363L00000X
FL9200776363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
111930OtherFACILITY MEDICARE PTAN
GA003135255AMedicaid
GA202I501044OtherMEDICARE PTAN
GRP 1855OtherMEDICARE GROUP PTAN