Healthcare Provider Details

I. General information

NPI: 1942768833
Provider Name (Legal Business Name): JESSICA CORNETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2019
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 S MAIN ST
FORT SCOTT KS
66701-3026
US

IV. Provider business mailing address

PO BOX 1832
PITTSBURG KS
66762-1832
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-9170
  • Fax: 620-231-5062
Mailing address:
  • Phone: 888-777-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019007957
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number81535
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: