MEDICARE: KARA NICOLE CORK PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1538938998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA NICOLE CORK PA

Provider Business Mailing Address
First Line	:	1818 HOLLY MEADOWS RD
Second Line	:
City	:	PARSONS
State	:	WV
Zip	:	26287-9006
Country	:	US
Telephone Number	:	740-213-5537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 HOLLY MEADOWS RD
Second Line	:
City	:	PARSONS
State	:	WV
Zip	:	26287-9006
Country	:	US
Telephone Number	:	740-213-5537
Fax Number	:

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

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	12/27/2023

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Directions to “ KARA NICOLE CORK PA” Practice Location

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