Individual
CORRIE LYNN FARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
409 W OAK ST, CARBONDALE, IL 62901-1464
(618) 529-4455
(618) 351-1287
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006937
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MULTI SPECIALTY GROUP PTAN
IL
Enumeration date
09/28/2018
Last updated
09/27/2022
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