Healthcare Provider Details

I. General information

NPI: 1306138219
Provider Name (Legal Business Name): CORKERN WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EUREKA ST SUITE A
BATESVILLE MS
38606-2533
US

IV. Provider business mailing address

314 WESTMORELAND CIR
BATESVILLE MS
38606-8456
US

V. Phone/Fax

Practice location:
  • Phone: 601-573-0386
  • Fax: 662-563-7277
Mailing address:
  • Phone: 601-573-0386
  • Fax: 662-563-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MISSY CORKERN
Title or Position: PRESIDENT
Credential: RN
Phone: 601-573-0386