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General NPI Number Information
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NPI Number | 1578896080
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Entity Type | Organization
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Legal Business Name | DR. PHYLLIS D. CORBITT PSC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 317 E MAIN ST
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City | WILMORE
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State | KY
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Zip | 40390-1323
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Country | US
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Telephone | 859-858-3219
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Fax | 859-858-3940
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Provider Business Mailing Address
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Address Line | 317 E MAIN ST
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City | WILMORE
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State | KY
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Zip | 40390-1323
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Country | US
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Telephone | 859-858-3219
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Fax | 859-858-3940
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PHYLLIS D CORBITT
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Credential | MD
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Telephone | 859-858-3219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14389
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License Number State | KY
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