Provider Demographics
NPI:1003465618
Name:DORMAN, COREY WAYNE (APRN)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:WAYNE
Last Name:DORMAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 W. CENTER ST.
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-6873
Mailing Address - Country:US
Mailing Address - Phone:501-628-9212
Mailing Address - Fax:
Practice Address - Street 1:2069 W. CENTER ST.
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-6873
Practice Address - Country:US
Practice Address - Phone:501-628-9212
Practice Address - Fax:501-232-9501
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily