Individual
CAROL ANN CORNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8612 OLIVE BLVD, SAINT LOUIS, MO 63132-2504
(314) 692-8055
(314) 692-5513
Mailing address
8612 OLIVE BLVD, SAINT LOUIS, MO 63132-2504
(314) 692-8055
(314) 692-5513
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2017029444
MO
363AM0700X
Medical Physician Assistant
PA 9106633
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017029444
STATE OF MISSOURI LICENSE
MO
01
—
PA 9106633
STATE OF FLORIDA LICENSE
FL
Enumeration date
08/08/2012
Last updated
12/06/2017
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