Individual
TARA M CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
48 EAST ST, FORT EDWARD, NY 12828-1811
(518) 824-8630
(518) 824-2302
Mailing address
9 CAREY RD, QUEENSBURY, NY 12804-7880
(518) 761-0300
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404226
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07361122
—
NY
Enumeration date
07/13/2022
Last updated
12/30/2025
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