Individual
AMIE J. CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
100 MALLARD CREEK RD STE 320, LOUISVILLE, KY 40207-5136
(502) 690-8782
(502) 459-0923
Mailing address
100 MALLARD CREEK RD STE 320, LOUISVILLE, KY 40207-5136
(502) 690-8782
(502) 459-0923
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1085051
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3004739
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100030510
KENTUCKY MEDICAID
KY
01
—
K066250
MEDICARE PTAN
KY
Enumeration date
08/09/2005
Last updated
01/29/2013
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