Basic Information
| Provider Information | |||||||||
| NPI: | 1073077681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORNETT | ||||||||
| FirstName: | ALFRED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 JACKS CREEK RD | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409726398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065996368 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1203 AMERICAN GREETING CARD RD | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407014811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065287010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747A0650X | KY | Y | Nursing Service Related Providers | Technician | Attendant Care Provider |
No ID Information.