Healthcare Provider Details

I. General information

NPI: 1114356458
Provider Name (Legal Business Name): ELIZABETH COBLENTZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP STE 10
RICHMOND KY
40475-2400
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-6501
  • Fax: 859-624-6509
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1112063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: