Healthcare Provider Details

I. General information

NPI: 1104838945
Provider Name (Legal Business Name): JANET K. CORBETT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANET BURTON

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

IV. Provider business mailing address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2345
  • Fax: 479-890-2497
Mailing address:
  • Phone: 479-968-2345
  • Fax: 479-890-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR9D62
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9D62
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-10813
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: