Individual
MRS. SHELLIA ANNE KORNEGAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1515 WEST 42ND STREET, PINE BLUFF, AR 71602
(870) 541-7111
Mailing address
1515 W 42ND AVE, PINE BLUFF, AR 71603-7004
(870) 541-7111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AO3247
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180128758
—
AR
Enumeration date
07/20/2009
Last updated
11/15/2013
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