Organization
MAIN STREET CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIANNA CORNETT APRN-FNP (OWNER)
(606) 233-1132
Entity
Organization
Contact information
Practice address
900 E MAIN ST, CUMBERLAND, KY 40823-1714
(606) 233-1132
Mailing address
PO BOX 320, CUMBERLAND, KY 40823-0320
(606) 233-1132
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3008624
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100298620
—
KY
Enumeration date
04/30/2015
Last updated
05/02/2016
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