Individual
KORI L CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3105 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 902-7527
(217) 902-7755
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001261
IL
Other
Enumeration date
10/04/2005
Last updated
04/23/2019
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