Healthcare Provider Details

I. General information

NPI: 1679365498
Provider Name (Legal Business Name): BOBBI NICOLE CARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

775 BRIDGEPORT AVE APT 302
STREETSBORO OH
44241-4058
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7211
  • Fax:
Mailing address:
  • Phone: 937-304-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: