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General NPI Number Information
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NPI Number | 1124258553
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Entity Type | Individual
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Provider Name | SHELLIA ANNE KORNEGAY APN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 1515 WEST 42ND STREET
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City | PINE BLUFF
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State | AR
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Zip | 71602
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Country | US
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Telephone | 870-541-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 W 42ND AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-7004
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Country | US
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Telephone | 870-541-7111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AO3247
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License Number State | AR
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