Provider Demographics
NPI:1093880791
Name:CORBETT, KYRA
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:IA
Mailing Address - Zip Code:52206-4700
Mailing Address - Country:US
Mailing Address - Phone:319-466-6231
Mailing Address - Fax:319-466-6232
Practice Address - Street 1:401 CARDINAL AVE
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:IA
Practice Address - Zip Code:52206-4700
Practice Address - Country:US
Practice Address - Phone:319-466-6231
Practice Address - Fax:319-466-6232
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist