Individual
DR. CLAY CORNELISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
500 S 11TH AVE, POCATELLO, ID 83201-4835
(208) 232-6214
Mailing address
500 S 11TH AVE, POCATELLO, ID 83201-4835
(208) 232-6214
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
222123
ID
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/29/2021
Last updated
02/24/2026
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