Provider Demographics
NPI:1003548819
Name:KORNBLET, VALARIE (CNC)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:
Last Name:KORNBLET
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 RIDGECORDE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7609
Mailing Address - Country:US
Mailing Address - Phone:314-853-0051
Mailing Address - Fax:
Practice Address - Street 1:463 RIDGECORDE PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7609
Practice Address - Country:US
Practice Address - Phone:314-853-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
132700000X, 171WH0202X, 172V00000X, 251B00000X, 171M00000X
MO1220823249133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome Modifications
No172V00000XOther Service ProvidersCommunity Health Worker
No251B00000XAgenciesCase Management