Healthcare Provider Details

I. General information

NPI: 1629992698
Provider Name (Legal Business Name): ANGELA KAY CORNETT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE K CORNETT LMT

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 KALISTE SALOOM RD APT 1011
LAFAYETTE LA
70508-4955
US

IV. Provider business mailing address

1019 KALISTE SALOOM RD APT 1011
LAFAYETTE LA
70508-4955
US

V. Phone/Fax

Practice location:
  • Phone: 812-606-2368
  • Fax:
Mailing address:
  • Phone: 812-606-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA-10472
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: