Provider Demographics
NPI:1346283470
Name:CORKERY, SUSAN KELLY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KELLY
Last Name:CORKERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 PLEASANT POINT DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1164
Mailing Address - Country:US
Mailing Address - Phone:843-757-1173
Mailing Address - Fax:866-527-0937
Practice Address - Street 1:335 PLEASANT POINT DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1164
Practice Address - Country:US
Practice Address - Phone:843-757-1173
Practice Address - Fax:866-527-0937
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334040363LF0000X
NC0050-01798363LF0000X
SC3430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1525Medicaid
SCNP1525Medicaid