Provider Demographics
NPI:1275087850
Name:CORBETT, MARY LIN (AGPC-NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LIN
Last Name:CORBETT
Suffix:
Gender:F
Credentials:AGPC-NP
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Other - Credentials:
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7364
Mailing Address - Fax:502-568-7136
Practice Address - Street 1:1120 CRISTLAND RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4150
Practice Address - Country:US
Practice Address - Phone:502-367-0104
Practice Address - Fax:502-358-5208
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
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Provider Licenses
StateLicense IDTaxonomies
KY3010355363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology