Individual
BRENTON WAYNE KORNEGAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LBSW
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 335-3022
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
(817) 569-4300
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
30113
TX
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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