Provider Demographics
NPI:1134470214
Name:CORLEY, TODD JAMES (CNP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:JAMES
Last Name:CORLEY
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76576 JOHNSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:KIMBOLTON
Mailing Address - State:OH
Mailing Address - Zip Code:43749-9535
Mailing Address - Country:US
Mailing Address - Phone:330-802-2123
Mailing Address - Fax:234-706-5265
Practice Address - Street 1:76576 JOHNSON RUN RD
Practice Address - Street 2:
Practice Address - City:KIMBOLTON
Practice Address - State:OH
Practice Address - Zip Code:43749-9535
Practice Address - Country:US
Practice Address - Phone:330-802-2123
Practice Address - Fax:330-686-2782
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13855-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health