Individual
LISA KORNEGAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
212 W PARK AVE, GREENWOOD, MS 38930-3009
(662) 453-8505
Mailing address
212 W PARK AVE, GREENWOOD, MS 38930-3009
(662) 453-8505
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
916316
MS
Other
Enumeration date
12/29/2020
Last updated
12/29/2020
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