Healthcare Provider Details

I. General information

NPI: 1730009572
Provider Name (Legal Business Name): COBY DALE ATWELL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BOONE RIDGE DR STE 1002
JOHNSON CITY TN
37615-4993
US

IV. Provider business mailing address

121 BOONE RIDGE DR STE 1002
JOHNSON CITY TN
37615-4993
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-5988
  • Fax: 423-794-1842
Mailing address:
  • Phone: 423-794-5988
  • Fax: 423-794-1842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42473
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: