Healthcare Provider Details

I. General information

NPI: 1487790747
Provider Name (Legal Business Name): BOBBIE R TOBAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

2403 INDIANA AVE BLDG 2403
FORT CAMPBELL KY
42223-5314
US

V. Phone/Fax

Practice location:
  • Phone: 270-412-5114
  • Fax: 931-490-1062
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80724
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: