Individual
JESSICA M CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
478 WHIRLAWAY DR STE 100, DANVILLE, KY 40422-9037
(859) 236-6613
(859) 236-2284
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 864-1472
(270) 864-1693
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA515
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95000824
—
KY
Enumeration date
09/15/2006
Last updated
10/22/2020
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