Healthcare Provider Details

I. General information

NPI: 1235853425
Provider Name (Legal Business Name): MS. COURTNEY C COLOBRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MIDWAY MEDICAL PARK
BRISTOL TN
37620-1653
US

IV. Provider business mailing address

2316 BRIARCLIFF RD
KINGSPORT TN
37660-4711
US

V. Phone/Fax

Practice location:
  • Phone: 423-652-0260
  • Fax: 423-652-0694
Mailing address:
  • Phone: 865-803-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number35682
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number175777
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: