Provider Demographics
NPI:1952940207
Name:KOBIA, KELLY N (BSN, RN, DNAP,CRNA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:N
Last Name:KOBIA
Suffix:
Gender:F
Credentials:BSN, RN, DNAP,CRNA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:N
Other - Last Name:GILLENWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN, DNAP,CRNA
Mailing Address - Street 1:213 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1705
Mailing Address - Country:US
Mailing Address - Phone:540-224-5374
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-981-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-04
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001198100163W00000X, 367500000X
NC007058367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse