MEDICARE: COREY L SHOEMAKER

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	F0813236	MS

General Provider Information

NPI Number	:	1629403704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY L SHOEMAKER

Provider Business Mailing Address
First Line	:	1123 HIGHWAY 35 S
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-8829
Country	:	US
Telephone Number	:	601-469-4771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123 HIGHWAY 35 S
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-8829
Country	:	US
Telephone Number	:	601-469-4771
Fax Number	:

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

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	09/09/2013

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Directions to “ COREY L SHOEMAKER ” Practice Location

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