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NPI Code Detail

MEDICARE: MARY LIN CORBETT AGPC-NP

MEDICARE:   MARY LIN CORBETT  AGPC-NP
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
1363LA2200XAdult Health Nurse Practitioner3010355KY
2363LG0600XGerontology Nurse Practitioner3010355KY

General Provider Information

NPI Number : 1275087850
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LIN CORBETT AGPC-NP
Provider Business Mailing Address
First Line : 12201 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2361
Country : US
Telephone Number : 502-568-7364
Fax Number : 502-568-7136
Provider Business Practice Location Address
First Line : 1120 CRISTLAND RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40214-4150
Country : US
Telephone Number : 502-367-0104
Fax Number : 502-358-5208
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2016
Last Update Date : 08/11/2016

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Directions to “ MARY LIN CORBETT AGPC-NP” Practice Location

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