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General NPI Number Information
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NPI Number | 1134470214
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Entity Type | Individual
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Provider Name | TODD JAMES CORLEY CNP
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Gender | Male
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 76576 JOHNSON RUN RD
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City | KIMBOLTON
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State | OH
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Zip | 43749-9535
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Country | US
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Telephone | 330-802-2123
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Fax | 330-686-2782
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Provider Business Mailing Address
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Address Line | 76576 JOHNSON RUN RD
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City | KIMBOLTON
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State | OH
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Zip | 43749-9535
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Country | US
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Telephone | 330-802-2123
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Fax | 234-706-5265
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 13855-NP
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License Number State | OH
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