Healthcare Provider Details

I. General information

NPI: 1750108403
Provider Name (Legal Business Name): ABIGAIL COBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

20288 CUMBERLAND RD
NOBLESVILLE IN
46062-9547
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-6262
  • Fax:
Mailing address:
  • Phone: 317-518-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004545A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: