Healthcare Provider Details

I. General information

NPI: 1811882459
Provider Name (Legal Business Name): BRANAN KELSEY COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

3700 GLENWILLOW WAY
LOUISVILLE KY
40299-3305
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax:
Mailing address:
  • Phone: 828-406-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4053744
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4053744
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: