Individual
JACK CORBETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10415 WALLACE ALLEY ST, KINGSPORT, TN 37663-3936
(252) 227-6557
Mailing address
10415 WALLACE ALLEY ST, KINGSPORT, TN 37663-3936
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
239734
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
37987
TN
Other
Enumeration date
02/14/2023
Last updated
02/18/2025
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