Individual
JENNIFER CORNELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
961 OAK RIDGE TPKE, OAK RIDGE, TN 37830-8832
(865) 296-4190
Mailing address
PO BOX 1028, KINGSTON, TN 37763-1028
(865) 123-4567
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0000129572
TN
Other
Enumeration date
11/03/2021
Last updated
02/08/2022
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