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General NPI Number Information
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NPI Number | 1326062316
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Entity Type | Individual
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Provider Name | MARY ANETA CORLEY RN, CFNP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 123 N MAIN ST
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City | LONE STAR
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State | TX
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Zip | 75668-2223
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Country | US
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Telephone | 903-656-0633
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Fax | 903-656-0636
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Provider Business Mailing Address
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Address Line | 4002 TECHNOLOGY CTR
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City | LONGVIEW
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State | TX
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Zip | 75605-2697
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Country | US
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Telephone | 903-247-0484
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Fax | 903-247-0485
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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 | 437214
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP107303
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License Number State | TX
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