Healthcare Provider Details

I. General information

NPI: 1417482845
Provider Name (Legal Business Name): LINDSEY KOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY YARDE

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W 7TH ST
AUBURN IN
46706-2014
US

IV. Provider business mailing address

534 COUNTY ROAD 54
GARRETT IN
46738-9725
US

V. Phone/Fax

Practice location:
  • Phone: 260-553-1234
  • Fax:
Mailing address:
  • Phone: 260-553-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002627A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: