Healthcare Provider Details

I. General information

NPI: 1609960830
Provider Name (Legal Business Name): CORBIN PEDIATRIC ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BRYAN BOULEVARD STE 200
CORBIN KY
40701
US

IV. Provider business mailing address

60 BRYAN BOULEVARD STE 200
CORBIN KY
40701
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-9700
  • Fax: 606-528-8423
Mailing address:
  • Phone: 606-528-9700
  • Fax: 606-528-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900173
License Number StateKY

VIII. Authorized Official

Name: VERNON MITCHELL MAY
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 606-528-9700