NPIMap

Individual provider Active NPI

Elizabeth Coblentz, NP

  • Nurse Practitioner
  • Berea, KY
National Provider Identifier
1114356458
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1112063 Issued in KY
Practice address
2750 Battlefield Memorial Hwy
Berea, KY 40403-8332
Phone
(859) 986-0302
Fax
(859) 986-0315
NPI assigned
Nov 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1112063 KY Primary

Addresses

Primary practice location

2750 Battlefield Memorial Hwy
Berea, KY 40403-8332

Mailing address

PO Box 936
London, KY 40743-0936
Phone (606) 330-7818

Other identifiers 1

IdentifierTypeStateIssuer
7100273450MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140124001708 KY Practitioner - Nurse Practitioner 5991933764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
H2 Rehabilitation Services of Kentucky, LLC 187 clinicians
Baptist Health Medical Group Inc 2,431 clinicians

Practice addresses (Care Compare)

193 Glades Rd
Berea, KY 40403-2261
Phone (859) 956-1055

793 Eastern Byp
Suite 213
Richmond, KY 40475-2440
Phone (859) 624-6501

Hospital & facility affiliations

  • Baptist Health Richmond Hospital, Richmond, KY, CCN 180049
  • Marcum and Wallace Memorial Hospital Hospital, Irvine, KY, CCN 181301

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1112063KYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc Nurse Practitioner CurrentSince May 1, 2023 Accepting new patients
Baptist Health Medical Group Inc CurrentSince May 1, 2023 Accepting new patients
Baptist Health Medical Group Inc Nurse Practitioner Past Accepting new patients
Saint Joseph Health System, Inc. Nurse Practitioner Past Accepting new patients

Locations

60 Mercy Ct
#3
Irvine, KY 40336

4071 Tates Creek Centre Dr
Ste 202
Lexington, KY 40517
Phone (859) 260-4390

793 Eastern Byp
Ste 213
Richmond, KY 40475
Phone (859) 624-6501

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1114356458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407430936",
            "telephone_number": "606-330-7818",
            "fax_number": "606-330-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 BATTLEFIELD MEMORIAL HWY",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "404038332",
            "telephone_number": "859-986-0302",
            "fax_number": "859-986-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBLENTZ",
        "first_name": "ELIZABETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "1112063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100273450",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berea, KY

Sources for this page

Verify at the official NPI Registry.