Healthcare Provider Details

I. General information

NPI: 1902737133
Provider Name (Legal Business Name): EMILY KATHRYN KOEBLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MAIN DR
WARREN PA
16365-5001
US

IV. Provider business mailing address

113 BIDDLE ST
WARREN PA
16365-2103
US

V. Phone/Fax

Practice location:
  • Phone: 814-706-8442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP035057
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: