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General NPI Number Information
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NPI Number | 1326543836
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Entity Type | Individual
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Provider Name | COLTON TYLER CORNETT DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 226 MEDICAL PLAZA LN
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City | WHITESBURG
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State | KY
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Zip | 41858-7425
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Country | US
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Telephone | 606-633-4871
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | WHITESBURG
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State | KY
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Zip | 41858-0040
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Country | US
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Telephone | 606-633-4823
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 05012
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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