Provider Demographics
NPI:1154058923
Name:COBLE, KRISTIN DENICE (AGACNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DENICE
Last Name:COBLE
Suffix:
Gender:
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 PICKWICK PL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1719
Mailing Address - Country:US
Mailing Address - Phone:708-289-1878
Mailing Address - Fax:
Practice Address - Street 1:1540 LAKE LANSING RD STE 203
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3757
Practice Address - Country:US
Practice Address - Phone:517-913-6711
Practice Address - Fax:517-913-6712
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314544363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily