MEDICARE: MRS. DAPHNE CORNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	S0412	MS

General Provider Information

NPI Number	:	1033353123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAPHNE CORNETT

Provider Business Mailing Address
First Line	:	118 COLLEGE DR
Second Line	:	#10035
City	:	HATTTIESBURG
State	:	MS
Zip	:	39406
Country	:	US
Telephone Number	:	601-266-5223
Fax Number	:	601-266-6763

Provider Business Practice Location Address
First Line	:	118 COLLEGE DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0002
Country	:	US
Telephone Number	:	601-266-5223
Fax Number	:	601-266-6763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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Directions to “ MRS. DAPHNE CORNETT ” Practice Location

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