Provider Demographics
NPI:1962050898
Name:COBERN, TARICKA NICOLE
Entity type:Individual
Prefix:
First Name:TARICKA
Middle Name:NICOLE
Last Name:COBERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARICKA
Other - Middle Name:
Other - Last Name:FLANNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 PRIVATE DR. 19423
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680
Mailing Address - Country:US
Mailing Address - Phone:740-451-0741
Mailing Address - Fax:
Practice Address - Street 1:178 PRIVATE DR. 19423
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680
Practice Address - Country:US
Practice Address - Phone:740-451-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management