Healthcare Provider Details

I. General information

NPI: 1073809786
Provider Name (Legal Business Name): JEANNE SOVEK CORNETT FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MCLAWS CIR STE 105
WILLIAMSBURG VA
23185-5674
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-5600
  • Fax:
Mailing address:
  • Phone: 248-824-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001193123
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: