Healthcare Provider Details

I. General information

NPI: 1598674178
Provider Name (Legal Business Name): KEVIN CORNINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NW 5TH ST
OKEECHOBEE FL
34972-2565
US

IV. Provider business mailing address

911 SW 2ND ST
OKEECHOBEE FL
34974-4102
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-8268
  • Fax:
Mailing address:
  • Phone: 863-273-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: