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DR. ANGELA PETTIT CORNELIUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1541 KINGS HWY, ATTN: PAYORCREDENTIALING, SHREVEPORT, LA 71103-4228

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD.205908
LA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
M6338
TX
207Q00000X
Family Medicine Physician
BP1-0018144
TX
207Q00000X
Family Medicine Physician
MD.205908
LA

Other

Enumeration date
06/14/2007
Last updated
07/24/2025
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