MEDICARE: KRISTEN MARIE COBB RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	5428762	SC

General Provider Information

NPI Number	:	1184409146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE COBB RN

Provider Business Mailing Address
First Line	:	PO BOX 23321
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-4321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COURTENAY DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	843-792-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	04/09/2026

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