Healthcare Provider Details

I. General information

NPI: 1487003109
Provider Name (Legal Business Name): ASHLEY KOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY EWENS

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HASTINGS LN
ELIZABETH CITY NC
27909-3324
US

IV. Provider business mailing address

208 HASTINGS LN
ELIZABETH CITY NC
27909-3324
US

V. Phone/Fax

Practice location:
  • Phone: 262-909-6485
  • Fax:
Mailing address:
  • Phone: 262-909-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: