MEDICARE: MRS. KELLY LYNN COBB FNP-BC

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	363LF0000X	Family Nurse Practitioner	201882	NC

General Provider Information

NPI Number	:	1316926348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY LYNN COBB FNP-BC

Provider Business Mailing Address
First Line	:	3876 NC HIGHWAY 86 S
Second Line	:
City	:	YANCEYVILLE
State	:	NC
Zip	:	27379-9426
Country	:	US
Telephone Number	:	336-694-6223
Fax Number	:

Provider Business Practice Location Address
First Line	:	189 COUNTY PARK RD
Second Line	:
City	:	YANCEYVILLE
State	:	NC
Zip	:	27379-9376
Country	:	US
Telephone Number	:	336-694-4129
Fax Number	:	336-694-7030

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/26/2021

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