Individual
DR. KATHRYN GOODWIN CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 MT CARMEL WAY, PITTSBURG, KS 66762-7587
(620) 231-6100
Mailing address
4530 SE 105TH ST, GALENA, KS 66739-4103
(417) 529-0305
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
04-43847
KS
207P00000X
Emergency Medicine Physician
2002012667
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20008990A
MEDICAID
OK
05
—
204642102
—
MO
05
—
243419306
—
MO
Enumeration date
06/07/2006
Last updated
10/09/2020
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