Healthcare Provider Details

I. General information

NPI: 1407332000
Provider Name (Legal Business Name): ZACHARY JARRID CORNETT APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 OSBORNE WAY STE B
GEORGETOWN KY
40324-9636
US

IV. Provider business mailing address

2901 PIGEON ROOST RD
RUSH KY
41168-8132
US

V. Phone/Fax

Practice location:
  • Phone: 502-735-0400
  • Fax: 606-547-4295
Mailing address:
  • Phone: 606-928-6648
  • Fax: 606-928-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3012377
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: