Provider Demographics
NPI:1023036381
Name:CORBIN, KATHY G (CFNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:G
Last Name:CORBIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:G
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:1640 BREAZEALE SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4278
Mailing Address - Country:US
Mailing Address - Phone:318-357-2061
Mailing Address - Fax:318-521-6086
Practice Address - Street 1:804 N BEECH ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3809
Practice Address - Country:US
Practice Address - Phone:318-238-1274
Practice Address - Fax:337-239-2225
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121128Medicaid
MS02I500812Medicare PIN
MS500001223Medicare ID - Type Unspecified
MSC02705Medicare UPIN
MS121128Medicare UPIN