Healthcare Provider Details

I. General information

NPI: 1619489952
Provider Name (Legal Business Name): STEVEN GEORGE ALLEN CORNETT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LIMESTONE
LEXINGTON KY
40508-3008
US

IV. Provider business mailing address

310 S LIMESTONE
LEXINGTON KY
40508-3008
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-9399
  • Fax: 859-257-0418
Mailing address:
  • Phone: 859-226-7006
  • Fax: 859-226-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011614
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3011614
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: