Healthcare Provider Details

I. General information

NPI: 1376300889
Provider Name (Legal Business Name): MARANDA LYNN GOBLE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 EUCLID AVE STE 1
PAINTSVILLE KY
41240-1167
US

IV. Provider business mailing address

900 TOM FRAZIER WAY STE 200
SALYERSVILLE KY
41465-7686
US

V. Phone/Fax

Practice location:
  • Phone: 66-889-1602
  • Fax: 606-263-4467
Mailing address:
  • Phone: 606-349-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4016787
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: