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General NPI Number Information
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NPI Number | 1356840615
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Entity Type | Individual
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Provider Name | JAMIE KATHERYN CORNEJO DNP, NP-C, BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1400 BROADFIELD BLVD STE 200
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City | HOUSTON
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State | TX
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Zip | 77084-5162
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Country | US
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Telephone | 914-919-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 230 MACEY LN
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City | BOSSIER CITY
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State | LA
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Zip | 71111-8212
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Country | US
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Telephone | 832-607-4805
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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 | AP135844
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | AP135844
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License Number State | TX
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